The interplay between gut microbiota and gestational diabetes mellitus: mechanisms, characteristics, and intervention strategies.

Gestational diabetes mellitus (GDM) is a common metabolic complication during pregnancy that poses significant risks to maternal and infant health and is closely associated with gut microbiota dysbiosis. This review systematically summarizes the mechanisms, characteristic alterations, and intervention strategies related to the interplay between gut microbiota and GDM. Studies have shown that women with GDM exhibit distinct structural and compositional dysbiosis of the gut microbiota, such as an altered Firmicutes/Bacteroidetes ratio, reduced abundance of beneficial bacteria, and enrichment of pathogenic bacteria. This dysbiosis is associated with altered synthesis of metabolites such as short-chain fatty acids and bile acids, which may impair insulin signaling, compromise barrier function, and activate inflammatory responses, potentially playing a role in GDM pathogenesis. Furthermore, GDM-associated gut dysbiosis can be vertically transmitted to offspring, altering neonatal gut colonization and increasing long-term risks of metabolic and neurodevelopmental disorders. Diagnostic models based on gut microbiota features show promise for early GDM prediction. Interventions targeting the gut microbiota, including lifestyle modifications, probiotics/prebiotics supplementation, and fecal microbiota transplantation, have demonstrated potential in improving glucose metabolism by modulating microbial composition. However, current research faces challenges such as high heterogeneity, unclear causal mechanisms, and difficulties in clinical translation. Future studies should integrate multi-omics approaches and prospective cohorts to elucidate the core mechanisms of gut microbiota in GDM and advance personalized prevention and management strategies.