Prevalence and associated factors of gestational diabetes mellitus among women with polycystic ovary syndrome: a systematic review and meta-analysis.

Polycystic ovary syndrome (PCOS), the most common endocrine disorder in reproductive-aged women, often leads to gestational diabetes mellitus (GDM). This study aimed to systematically evaluate GDM prevalence and its associated factors in PCOS. We searched PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, Sinomed, and VIP from inception to December 31, 2025. Studies reporting GDM prevalence or associated factors in PCOS were included. A random-effects model pooled prevalence with odds ratios. Egger's test assessed publication bias, and subgroup analysis with meta-regression explored heterogeneity. A logit transformation was applied for pooling. Twenty-two studies with 5,507 PCOS patients were included. The pooled GDM prevalence was 24% (95% CI: 20%-28%; prediction interval: 10%-46%), with substantial heterogeneity (I² = 89.9%). The primary prevalence estimate, based on cohort studies (n=13), was 21.7% (95% CI: 17.7%-25.8%), while the overall estimate including case-control studies was 24% (95% CI: 20%-28%). By diagnostic criteria, GDM prevalence was 26.0% for one-step vs. 18.7% for two-step. Potentially associated factors included pre-pregnancy BMI (OR = 1.39), gestational weight gain (OR = 1.58), HOMA-IR (OR = 3.41), and family history of diabetes (OR = 2.88). Although the pooled GDM prevalence in PCOS was 24%, substantial heterogeneity and a wide prediction interval (10%-46%) suggest the true prevalence varies considerably across settings. Associated factors included HOMA-IR, family history, pre-pregnancy overweight, and excessive gestational weight gain. PCOS patients should be considered a high-risk group, and early monitoring of glucose metabolism and weight management may be beneficial, though these recommendations derive from observed rather than interventional evidence. https://www.crd.york.ac.uk/PROSPERO/view/CRD42026128476, identifier: CRD420261284765.