Abstract
Bipolar disorder (BD) is associated with increased cardiometabolic risk, contributing to elevated morbidity and premature mortality. Childhood trauma (CT) is a common environmental risk factor in BD and may exacerbate metabolic dysfunction, but no prior systematic synthesis has focused on their intersection. The objective of this review was to systematically review and synthesize evidence on the association between childhood trauma exposure and metabolic biomarkers in adults with bipolar disorder. This review adhered to PRISMA 2020 guidelines and was registered in PROSPERO (ID CRD420251045565). A comprehensive search of PubMed/MEDLINE, Web of Science, Scopus, and Embase (from inception to September 2025) was conducted. Eligible studies were peer-reviewed observational studies assessing associations between CT and metabolic markers (eg, BMI, lipids, HbA1c, hs-CRP) in adult BD populations. Data extraction and NIH quality assessments were performed independently by multiple reviewers. Sixteen studies were included (total n ≈ 6,200 across study samples). CT was significantly associated with higher body mass index and elevated hs-CRP. Two third of studies reported adverse associations with lipid profiles, and one study showed increased HbA1c among CT-exposed BD patients. Most findings emerged from cross-sectional designs, though one longitudinal study revealed large effect sizes across multiple metabolic markers. CT is consistently associated with adverse metabolic outcomes in individuals with BD, particularly elevated BMI, inflammation, and dyslipidemia. These findings support the need for trauma-informed metabolic screening and personalized interventions in this subgroup BD population. Further prospective studies are warranted to elucidate causal pathways and inform personalized care.