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              <p>Background: Gestational diabetes mellitus (GDM) increases risks of adverse perinatal outcomes and metabolic disorders in offspring. Some endocrine-disrupting chemicals are presumed to interfere with glucose metabolism. We aimed to assess the association between non-occupational exposures to pesticides and the risk of GDM.Methods: The study was conducted on 11 512 women (791 with GDM) from the French nationwide Elfe cohort. Among 114 suspected pesticides identified using a toxicogenomic approach, 62 with detection frequency ≥10 % were analyzed across three sources of exposure: residential use (self-reported, n = 18), agricultural (geographic information system, n = 14) and dietary (estimated by a food-frequency questionnaire and monitoring data of pesticide residues in foods, n = 30). The association between exposure to pesticides (no or low vs. high) and the occurrence of GDM was tested with single and multi-source adjusted logistic regression models.Results: In the multi-source model, dietary exposure to glyphosate (aOR = 0.6, 95 %CI: 0.5,0.9) or agricultural exposure (aOR = 0.8, 95 %CI:0.6,1.0) were associated with lower odds of GDM. The same effect was identified for two dietary pesticides: epoxiconazole (aOR = 0.6, 95 %CI: 0.5,0.8) and penconazole (aOR = 0.8, 95 %CI: 0.6,1.0). Dietary exposure to cypermethrin (aOR = 1.2, 95 %CI:1.0,1.5) and agricultural exposure to myclobutanil (aOR = 1.4, 95 %CI:1.1,1.9) were associated with higher odds of GDM. No significant association was identified for the residential use of pesticides.Conclusion: This toxico-genomic-based study identifies five pesticides associated with GDM through agricultural or dietary exposure. These findings provide new insights into environmental contributors to GDM. Further research is needed to elucidate the underlying toxicological mechanisms and confirm these associations.</p>
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