Gestational diabetes mellitus in low- and middle-income countries: a systematic review and meta-analysis of associated factors.

Gestational Diabetes Mellitus (GDM) is a major public health problem. This study aimed to conduct a systematic review and meta-analysis to identify the factors associated with GDM in Low- and Middle-Income Countries (LMICs). Seven electronic databases (PubMed, CINAHL, PsycINFO, Scopus, EMBASE, CABI and Google Scholar) were systematically searched for eligible observational studies published in LMICs between 2015 and August 2025. Statistical heterogeneity was evaluated using the I2 statistic, and a random-effects model was applied to calculate pooled estimates. The protocol was pre-registered on PROSPERO (CRD420251247717). Forty-seven studies met the inclusion criteria and contributed 116 factor-specific effect estimates. The pooled analysis demonstrated that several factors were significantly associated with increased risk of GDM. These included maternal age ≥ 30, multiparity, urban residence, pre-pregnancy obesity BMI ≥ 25 kg/m2, family history of diabetes, history of gestational diabetes mellitus (GDM), pre-hypertension, preeclampsia, polycystic ovarian syndrome (PCOS) and physical inactivity. This study found that advanced maternal age, pre-pregnancy obesity, family history of diabetes, prior GDM, pre-hypertension, preeclampsia, and PCOS are key factors associated with GDM in LMICs. These findings highlight the need for prevention and screening strategies integrated within maternal pregnant health programs for many LMICs.