Gestational Diabetes and Cardiovascular Risk in Women: A Comprehensive Review of Thrombosis, Hemostasis, and Emerging Insights Into Coagulation and Fibrinolysis.

Background Gestational diabetes mellitus (GDM) has been increasingly associated with heightened cardiovascular and thrombotic risk. This study aimed to evaluate hemostatic and metabolic profiles in women with GDM to explore early markers of vascular dysfunction. Methods A retrospective cross-sectional study was conducted among 250 pregnant women diagnosed with GDM between December 2022 and October 2023 at multiple tertiary healthcare facilities in Pakistan. Only GDM cases were included; normoglycemic controls were not part of this analysis. Cardiovascular risk was assessed using surrogate markers, including fibrinogen, D-dimer, plasminogen activator inhibitor-1 (PAI-1), and antithrombin, in conjunction with clinical data such as blood pressure, BMI, smoking status, and comorbidities. Threshold values were interpreted relative to gestational-age norms where available. The influence of treatment modalities (insulin, metformin, diet) was explored. Ethical approval was obtained from the institutional review board prior to data access. Results Women with GDM showed elevated levels of fibrinogen (mean: 3.48 g/L), D-dimer (mean: 863 ng/mL), and PAI-1, along with reduced antithrombin activity, suggestive of a prothrombotic state. Comorbidities such as obesity, hypertension, and tobacco use appeared to amplify this risk. No significant differences were found in hemostatic markers across treatment modalities. Conclusion GDM was associated with biochemical evidence of vascular strain and thrombogenicity. These findings highlight the potential value of integrated hemostatic and cardiovascular surveillance during pregnancy. Further studies comparing GDM to normoglycemic pregnancies are warranted to confirm causality and refine risk stratification.