PAPPA and gestational diabetes: This finding was further confirmed in a multicenter study, where an FHR threshold of 162 bpm showed a detection rate of 76.9%, specificity of 67.1%, and negative predictive value of 85.5% for GDM [20].Sweeting et al. constructed a multivariate prediction model that combined clinical risk factors with novel biomarkers, including PAPP-A, triglycerides, and lipocalin-2, which accurately predicted GDM in early pregnancy with an area under the curve of 0.93 (95% CI 0.89–0.96) for early GDM [21].PCOS is a risk factor for GDM and was confirmed in a study by Weerakiet S more than 10 years ago [1].