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In the UK, screening relies on risk factors at booking, followed by a diagnosis via an oral glucose tolerance test in the second trimester. This approach may lack sensitivity and has poor tolerability. Emerging evidence suggests that GDM pathophysiology begins in the first trimester, with biomarkers showing potential for early prediction. Identifying these could enable earlier risk stratification, improved diagnostic pathways, and better maternal\u2013fetal outcomes. This scoping review maps the existing literature on first\u2010trimester biomarkers of GDM to evaluate their clinical utility and integration into predictive models. A literature search was conducted using Medline, Embase, and PubMed to identify studies on first\u2010trimester biomarkers of GDM. Inclusion criteria included (1) studies investigating biomarkers at &lt;15\u2009weeks' gestation; (2) studies that diagnosed GDM using an OGTT with recognized diagnostic guidelines or clearly stated glucose thresholds. A total of 133 studies were included, reporting a wide range of biomarkers (145 in total). PAPP\u2010A was generally lower in GDM, with mixed findings for \u03b2\u2010hCG and PlGF. Metabolic markers, including lipid profiles, fasting glucose, and HbA1c, were often elevated. Inflammatory markers, such as WCC, neutrophils, and CRP, were higher in those later diagnosed with GDM. First\u2010trimester biomarkers highlight GDM's complex pathophysiology. PAPP\u2010A shows predictive potential, while metabolic and inflammatory biomarkers suggest early systemic dysfunction. Emerging tools like 3D ultrasonography indicate placental structural changes. Larger studies are needed to validate these biomarkers and integrate them into predictive models to improve maternal\u2013fetal outcomes.<\/jats:p>","DOI":"10.1111\/aogs.70046","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T12:41:27Z","timestamp":1756471287000},"page":"1838-1848","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["First\u2010trimester biomarkers of gestational diabetes mellitus: A\u00a0scoping review"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3979-6761","authenticated-orcid":false,"given":"May","family":"Swinburne","sequence":"first","affiliation":[{"name":"Nuffield Department of Women's and Reproductive Health University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3671-6978","authenticated-orcid":false,"given":"Samuel","family":"Krasner","sequence":"additional","affiliation":[{"name":"Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Mathewlynn","sequence":"additional","affiliation":[{"name":"Nuffield Department of Women's and Reproductive Health University of Oxford  Oxford UK"},{"name":"Oxford University Hospitals NHS Foundation Trust  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Collins","sequence":"additional","affiliation":[{"name":"Nuffield Department of Women's and Reproductive Health University of Oxford  Oxford UK"},{"name":"Birmingham Women and Children's NHS Foundation Trust  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2021-067946","article-title":"Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta\u2010analysis","volume":"377","author":"Ye W","year":"2022","journal-title":"BMJ"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.109050"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2022.10.001"},{"key":"e_1_2_14_5_1","unstructured":"FarrarD SimmondsM GriffinS et\u00a0al.Prevalence of gestational diabetes in the UK and Republic of Ireland: a systematic review. 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