Women with severe endometriosis are three times more likely to develop gestational diabetes than those with milder forms of the condition, according to a systematic review.

Based on data from 4.6 million women, Italian obstetricians also reported a 23% higher risk of gestational diabetes (GDM) associated with endometriosis, regardless of severity, compared with controls.

The researchers suggested that endometriosis “may be considered as a red flag” for diagnosing GDM and should be included alongside other risk factors routinely assessed during pregnancy.

“In this sense, the earlier and more specific detection of GDM in women with endometriosis could improve pregnancy management and final maternal–fetal outcomes,” they wrote in Scientific Reports.