Implication of Epigenetic Factors in Gestational Diabetes Mellitus and Macrosomia

Gestational diabetes mellitus (GDM) is a frequent complication during pregnancy, with its incidence having risen markedly over recent years. It is a major global public health issue linked to various complications, including a higher probability of Caesarean de-livery and the development of type 2 diabetes in mothers, as well as macrosomia or excessive fetal growth, a heightened risk of type 2 diabetes, obesity, and cardiovascular disease in the offspring's later stage of life. Recent advancements in epigenetics have shed light at the pathophysiology of GDM, offering new methods to identify women at high risk for developing GDM and experiencing postpartum complications. This review has explored the connection between epigenetic changes, such as DNA methylation, non-coding RNAs, and small extracellular vesicles (sEVs), and GDM. Non-coding RNAs and sEVs are gaining attention as potential biomarkers for forecasting the onset of GDM and its lasting health effects on mothers and offspring. Additionally, they could become future therapeutic targets. The potential of epigenetic modifications as biomarkers is underscored by their dynamic and reversible characteristics, making them valuable for early diagnosis, disease mon-itoring, and predicting pregnancy outcomes. Future studies should focus on longitu-dinal, multi-omics, and functional approaches to translate epigenetic findings into pre-cision medicine strategies for the prevention, diagnosis, and treatment of GDM.