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Gestational diabetes mellitus (GDM) is a frequent metabolic complication of pregnancy associated with significant maternal and neonatal morbidity. Its prevalence is notably higher among South Asian women, likely due to increased baseline insulin resistance and genetic predisposition. Conventional screening using the oral glucose tolerance test (OGTT), typically performed at 24-28 weeks of gestation, often identifies GDM after metabolic alterations are already established, thereby limiting opportunities for early intervention. This has led to growing interest in identifying reliable first-trimester biomarkers for early risk prediction. Adipokines, which play a crucial role in metabolic regulation and inflammation, have emerged as promising candidates. Omentin, an insulin-sensitizing adipokine predominantly secreted by visceral adipose tissue, has been implicated in glucose homeostasis. This study aimed to evaluate first-trimester serum omentin levels as a predictor of GDM and to assess its association with fetomaternal outcomes.

A prospective cohort study was conducted over a period of 18 months from July 2024 to December 2025 at Vardhman Mahavir Medical College (VMMC) and Safdurjung Hospital. Pregnant women aged 18-35 years with a singleton pregnancy and a normal two-hour OGTT at their first antenatal visit were enrolled. First-trimester venous blood samples were collected under standardized conditions, and serum omentin levels were measured using enzyme-linked immunosorbent assay (ELISA). Participants underwent repeat 75-g OGTT at 24-28 weeks and again at 32-34 weeks of gestation. All participants were followed until delivery to monitor the development of GDM and to document relevant maternal and neonatal outcomes.

Lower first-trimester serum omentin levels were significantly associated with subsequent development of GDM and demonstrated moderate predictive utility on receiver operating characteristic curve (ROC) analysis, with an area under the receiver operating characteristic curve (AUROC) of 0.683. At the optimal cutoff value, specificity was 83%, and the negative predictive value was 90.8%, indicating a strong capacity to identify women at low risk for developing GDM. A trend toward increased adverse fetomaternal outcomes was observed among women with lower omentin levels.

First-trimester serum omentin shows promise as an early predictive biomarker for GDM. Its incorporation into routine antenatal screening protocols may improve early risk stratification and facilitate timely preventive interventions. These findings support the potential role of adipokine-based screening strategies in enhancing current approaches to GDM detection and improving overall pregnancy outcomes.