While the idea of early biomarker testing is exciting, Dr Muthuswamy cautioned that practical challenges exist.
Published Oct 14, 2025 | 10:50 PM ⚊ Updated Oct 14, 2025 | 10:50 PM
Representational image. Credit: iStock
Synopsis: New research reveals gestational diabetes signs emerge in the first trimester, with over 140 biomarkers—like low PAPP-A and high glucose/cholesterol—identified in a review of 130 studies. This supports early screening for prevention, improving maternal and fetal outcomes. Experts advocate multidisciplinary care and personalized interventions but caution on validation needs and implementation challenges in resource-limited settings.
For years, gestational diabetes has been treated as a condition that emerges midway through pregnancy. But new evidence suggests that the biological signs of the disorder start showing up much earlier, even before many women realise they are at risk.
A new scoping review of more than 130 studies has found that subtle metabolic and inflammatory changes appear in the first trimester of pregnancy, long before gestational diabetes is typically diagnosed.
The researchers identified over 140 biomarkers linked to future risk, including lower levels of pregnancy-associated plasma protein A (PAPP-A) and higher levels of cholesterol, fasting glucose, and inflammatory markers such as CRP.
The findings strengthen the case for early screening and intervention, offering hope that gestational diabetes, a condition that affects millions of pregnancies worldwide, could one day be predicted and prevented before it ever takes hold.
“Without doubt, a multidisciplinary approach to any clinical problem will definitely improve the outcome,” said Dr Jaishree Gajaraj, Head of Varam and Senior Consultant, Department of Obstetrics and Gynaecology, Varam at MGM Healthcare, to South First.
“The same holds good for gestational diabetes and for diabetes complicating pregnancy.”
She stressed on the importance of preconception counseling for women with pre-existing diabetes and early screening for those with a prior history of gestational diabetes. In India, she explained, large-scale population screening has already become the norm, with all pregnant women undergoing testing for diabetes in pregnancy.
According to Gajaraj, a combined clinic model, where obstetricians and diabetologists work together, can make a significant difference. “Working together will improve blood sugars,” she said.
“Maintaining good sugar levels ensures the baby’s growth, reduces complications like excess amniotic fluid, and allows the pregnancy to continue safely up to term,” she added.
While early detection through biomarkers is an exciting prospect, Gajaraj warned that these tests must first be validated through large, randomised control trials before being integrated into routine antenatal care.
“Biomarkers are not inexpensive,” she pointed out, adding that, “the acceptance and compliance will be low, not only from patients but also from obstetric colleagues. We need to be very careful before rolling this out as a screening program.”
She stressed that labeling women as “high-risk” should not raise ethical concerns if done transparently.
“When we stratify a woman in early pregnancy as high-risk or low-risk, it simply means she needs extra care and monitoring,” she explained. “A little bit of counseling and communication with the woman and her family can ensure full cooperation.”
Early identification, she added, can improve prenatal outcomes by allowing timely interventions.
“The earlier we can screen and pick up the possibility of GDM developing, the better,” said Gajaraj.
She said it’s a welcome step for all obstetricians who care for pregnant women, but reminded that these biomarkers are not yet specific to diabetes and need much more validation before they can be used confidently as screening tools.
“Traditionally, we test for gestational diabetes only after 24 weeks, but this study shows the body starts showing changes much earlier,” said Dr Ravikiran Muthuswamy, Senior Consultant, Endocrinology, SIMS Hospital, Chennai. Low levels of PAPP-A or higher fasting glucose, cholesterol, and HbA1c, he explains, are “red flags” that may not be 100% accurate yet but clearly indicate women at higher risk for developing GDM.
He believe that these early metabolic changes justify moving screening to the first trimester.
“If we can identify high-risk mothers earlier, it helps us intervene sooner. Waiting until the second trimester means we are already late in many cases,” Muthuswamy notes.
While the idea of early biomarker testing is exciting, Muthuswamy cautioned that practical challenges exist.
“In big cities or tertiary hospitals, it may be possible. But in smaller towns or rural areas, adding expensive biomarker tests may not be realistic immediately,” he said. He suggested starting with simpler, widely available tests like fasting glucose or HbA1c, which are cost-effective and already accessible.
“Even small changes in diet, exercise, and weight management in the early weeks can have a big impact. If we know someone is at risk, we can counsel them right away, rather than waiting for diabetes to show up at 24–28 weeks. Prevention is always better than treatment,” said Muthuswamy on the benefits of acting early.
He also highlighted the role of personalised medicine in managing high-risk pregnancies.
“Every woman has a different risk profile, lifestyle, and genetics. If biomarkers can tell us who is more likely to develop GDM, we can tailor diet plans, physical activity, and monitoring schedules. This approach improves outcomes not just for the mother but also for the baby in the long term,” he said.
Experts say identifying high-risk women early and providing timely interventions could be a game-changer, helping prevent complications and ensure healthier pregnancies for both mother and baby.
(Edited by Amit Vasudev)
