Extracellular Vesicles in Gestational Diabetes Mellitus: Pathogenesis, Diagnosis, and Therapy.

Gestational diabetes mellitus (GDM) is the most common metabolic complication of pregnancy, with a continuously rising global prevalence. However, current diagnostic and therapeutic strategies are limited by delayed detection and insufficient targeting. Extracellular vesicles (EVs), as nanoscale messengers that mediate intercellular communication, have recently been implicated in GDM pathogenesis and exhibit dual potential as liquid biopsy biomarkers and drug delivery vehicles. This review systematically integrates research findings on EVs in GDM, constructs an EV-mediated multi-organ crosstalk network framework, and comparatively evaluates the diagnostic and therapeutic potential of EVs derived from the placenta, adipose tissue, blood, breast milk, and urine. And further discussed current challenges and future directions for clinical translation of EV-based strategies. It provides an integrative perspective on the pathogenesis, precision diagnosis, and treatment of GDM and offers critical guidance for advancing the clinical translation of EV-based strategies.