<![CDATA[Gestational diabetes mellitus (GDM) is a metabolic disorder characterized by impaired physiological adaptation to pregnancy, leading to increased maternal and neonatal morbidity. This systematic review aimed to synthesize current evidence regarding the role of adiponectin in maternal metabolic adaptation and its association with the pathogenesis of GDM. A literature search was conducted in accordance with the PRISMA 2020 guidelines across six electronic databases: PubMed, Scopus, ScienceDirect, SpringerLink, Google Scholar, and Taylor & Francis. Eligible studies were primary observational studies that quantitatively measured circulating adiponectin levels in singleton pregnancies without pre-existing diabetes, based on the PECO framework. Of the 2,309 records identified, 43 studies met the inclusion criteria for qualitative synthesis. The synthesis showed that women with gestational diabetes mellitus (GDM) tended to have lower circulating adiponectin levels than pregnant women with normal glucose tolerance. This alteration could be detected as early as the beginning of pregnancy and was associated with increased insulin resistance, as indicated by HOMA-IR and other metabolic parameters. The use of adiponectin in combination with other biomarkers, including the leptin-to-adiponectin ratio (LAR), showed potential for improving the identification of GDM risk compared with adiponectin alone. However, variations in study design, population characteristics, timing of measurement, and adjustment for confounding factors contributed to heterogeneity across studies. As the primary evidence was observational, causal relationships could not be established. In conclusion, Adiponectin has potential as a supportive biomarker for GDM risk stratification but cannot yet be used as a standalone diagnostic biomarker. Large-scale prospective longitudinal studies are needed to validate its predictive value, adequately control for confounding factors, and establish standardized clinical cut-off values]]>
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