Omics-enhanced models provide higher predictive accuracy for first-trimester gestational diabetes than conventional lipid indicatorsMulti-Omics Data May Improve Early Prediction of Gestational Diabetes

Gestational diabetes mellitus (GDM) affects roughly one in seven pregnancies worldwide, yet diagnosis by oral glucose tolerance testing at 24–28 weeks of gestation leaves only a narrow window for intervention. The demonstrated benefit of treating early-diagnosed GDM has intensified interest in first-trimester prediction. This narrative review synthesises recent advances in early-pregnancy biomarkers for GDM, shifting the emphasis from biomarker discovery to clinical translation. Conventional lipid indicators and composite indices provide moderate predictive power at minimal cost (odds ratios 1.4–1.7; AUCs 0.75–0.82). Metabolomic and lipidomic studies have identified recurrent signatures — phospholipid remodelling, glycerolipid accumulation, fatty acid and acylcarnitine excess, branched-chain amino acids and bile acids — that map onto insulin resistance, lipotoxicity and hepatic steatosis, and omics-enhanced models report derivation-stage AUCs of approximately 0.83–0.95 with apparent incremental value over clinical factors alone, although these estimates derive predominantly from small cohorts that have rarely undergone external validation. Gut-microbiome features, thyroid parameters and environmental exposures further widen the aetiological frame. Translation remains limited, however, by small derivation cohorts, scarce external validation, analytical heterogeneity and the absence of trials testing biomarker-guided early intervention. We propose a pragmatic roadmap towards clinically deployable first-trimester prediction, with particular attention to high-burden Asian populations.