Circulating Levels of Remnant Cholesterol as Potential Biomarkers for Predicting Gestational Diabetes: A Systematic Review.

OBJECTIVES: Gestational diabetes mellitus (GDM) is a common pregnancy complication with serious consequences for both mother and child. Current diagnostic methods are invasive and limited. The present study was conducted to evaluate circulating remnant cholesterol (RC) as a potential predictive and diagnostic biomarker for GDM. METHODS: The present study was conducted following PRISMA guidelines. Databases including Scopus, PubMed, Web of Science (WoS), Embase, ProQuest, Cochrane, and Google Scholar were searched up to August 2025 using standardized keywords. The search results were independently screened by two researchers in two stages. The quality of included articles was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS: Finally, 11 studies were included in this systematic review. Women who developed GDM had higher circulating RC levels than those who did not. Overall, higher RC levels in early pregnancy were linked to a greater risk of GDM, with even small increases in RC translating into a higher likelihood of the condition. Although the strength of this link varied across studies and one suggested a possible protective effect, the evidence points to a fairly consistent association. CONCLUSIONS: This systematic review indicates that circulating RC is a promising candidate biomarker for early risk stratification of GDM. RC levels in the first trimester show a significant positive association with GDM risk, highlighting its potential for clinical integration. Further studies are needed to define cutoffs, validate across populations, and confirm real-world applicability.