The pathogenesis of gestational diabetes mellitus (GDM) remains unclear. Recent studies have found that a dysbiosis of gut flora could lead to metabolism and immune system disorders in human beings, resulting in GDM. The gut microbiome changes can be affected by various factors, of which diet and antibiotic exposure are the most dominant. From the perspective of the gut microbiome changes, individualized dietary guidance, evidence-based administration of antibiotics, appropriate intake of prebiotics, and probiotics supplement may help prevent and treat GDM.

Autophagy is the process by which cells remove unnecessary or damaged cells or parts of cells, to allow for their orderly renewal. It occurs commonly in body cells, and is considered as a protection for cells and maintaining normal function and tissue structure in cells, such as human placental tissues. However, excessive autophagy can lead to cell death and pathological damage in tissue. An excessive autophagy response to hyperglycemia in women with gestational diabetes mellitus inhibits angiogenesis in the placenta, resulting in tissue ischemia and hypoxia, increased level of reactive oxygen species, and risk of adverse pregnancy outcomes.