Objective To investigate the relationship between the levels of serum glycosylated hemoglobin (HbA1c), serum visfatin, glucose and lipid metabolism and the perinatal outcome in pregnant women with normal glucose tolerance (NGT). Methods A total of 135 NGT pregnant women diagnosed by oral glucose tolerance test (OGTT) entered this study. Patients were divided into two groups, high HbA1c group (HbA1c≥5.5%, n=66) and normal HbA1c group (HbA1c＜5.5%, n=69). The clinical data were collected in two groups. HbA1c levels were measured by HPLC, and the serum visfatin levels were measured by ELISA method. The values of body mass index (BMI), pregnant weight gain, visfatin, glucose and lipid met-abolic levels were analyzed between two groups. The relationship between levels of HbA1c, visfatin, glucose and lipid metab-olism and perinatal outcome were compared between two groups.Results The values of mean pregnancy weight gain, visfa-tin, total cholesterol (TC), triacylglycerol (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL) were higher in high HbA1c group than those of normal HbA1c group. In NGT women with high HbA1c level,there were higher average birth weight, lower blood glucose level in newborn babies and higher rates of cesarean section. The incidences of polyhydram-nios, meconium-stained fluid, macrosomia and neonatal hypoglycemia were also higher in NGT women with high HbA 1c than those of normal HbA1c group. There was a positive relationship between HbA1c level, pregnant weight gain and visfatin and birth weight of newborn babies in 135 NGT pregnant women. Conclusion The excessive weight gain during pregnancy can induce the up-regulation of the visfatin level, resulting in the increased blood glucose level. The optimal timing and mode of delivery could prevent the occurrence of adverse pregnancy outcomes.