Objective To investigate the relationships of serum levels of Xenin-25 and activin A with pregnancy outcomes in patients with gestational diabetes mellitus (GDM).

Methods A total of 269 pregnant women with GDM admitted to our hospital between December 2020 and February 2023 were enrolled. Serum levels of Xenin-25 and activin A were measured, and pregnancy outcomes were recorded. Based on pregnancy outcomes, patients were divided into poor pregnancy outcome group (91 cases) and good pregnancy outcome group (178 cases). The influencing factors of adverse pregnancy outcomes of GDM patients and the predictive value of Xenin-25 and activin A for GDM pregnancy outcomes were analyzed.

Results The poor pregnancy outcome group had higher age, pre-pregnancy body mass index (BMI), proportion of adverse obstetric history, as well as levels of fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), and activin A compared to the good pregnancy outcome group, and serum level of Xenin-25 was lower in the poor pregnancy outcome group (P < 0.05). High HbA1c and high activin A levels were identified as risk factors for pregnancy outcomes in GDM patients, while high Xenin-25 was a protective factor for pregnancy outcomes (P < 0.05). The areas under the curve (AUCs) for predicting adverse pregnancy outcomes in GDM patients using Xenin-25 and activin A were 0.895 and 0.865, respectively, while the AUC for combined prediction was 0.981, which was higher than that of Xenin-25 or activin A alone(P < 0.05).

Conclusion Xenin-25 and activin A in GDM patients are associated with adverse pregnancy outcomes and can serve as biomarkers for predicting pregnancy outcomes.