Lipidomic signatures in gestational diabetes mellitus and postpartum type 2 diabetes mellitus: a narrative review of etiologic and predictive implications

Gestational diabetes mellitus (GDM) represents one of the most common complications of pregnancy, with a steadily increasing global prevalence. It serves as an independent risk factor for adverse pregnancy outcomes and confers long-term health consequences for both mothers and their offspring. Women with a history of GDM exhibit an approximately tenfold elevated risk of developing type 2 diabetes mellitus (T2DM). Although several traditional risk factors have been identified, they are insufficient for early GDM prediction. Moreover, early indicators of progression from GDM to postpartum T2DM remain limited, highlighting an urgent need for the discovery of novel biomarkers to facilitate early identification and risk prediction. In recent years, lipidomics has emerged as a powerful platform for characterizing the metabolic disturbances associated with GDM and its postpartum transition to T2DM, while also demonstrating promise for the identification of candidate predictive biomarkers. In this narrative review, we aim to comprehensively summarize the current evidence on the dual role of lipids and lipidomics-both in the etiology of GDM and postpartum T2DM, as well as their potential predictive applications. We further discuss the pathophysiological implications of altered lipid metabolism and outline future research priorities for biomarker validation and clinical translation.