Small Extracellular Vesicles in Gestational Diabetes Mellitus: Current Landscape and Emerging Diagnostic Horizons

Gestational diabetes mellitus (GDM) is a common metabolic disorder of pregnancy associated with significant maternal and neonatal morbidity and mortality. Current diagnostic strategies, particularly the oral glucose tolerance test (OGTT), are limited by late detection, variability in diagnostic criteria, and patient burden, highlighting the need for earlier and more reliable biomarkers. Small extracellular vesicles (sEVs) nanosized vesicles released by maternal, placental, and adipose tissues have emerged as promising candidates for liquid biopsy approaches in GDM. Their molecular cargos, including proteins, miRNAs, circRNAs, and lncRNAs, reflect the physiological or pathological state of the cell of origin and show distinct alterations in pregnancies complicated by GDM. These changes are linked to insulin resistance, inflammation, and placental dysfunction, suggesting a strong diagnostic potential. This review summarizes current knowledge on sEVs cargos as biomarkers for GDM and other pregnancy-related complications and highlights emerging perspectives on their role in the early detection and management of GDM.