Background <p>Gestational diabetes mellitus (GDM) is a significant public health issue characterized by hyperglycemia during pregnancy due to insulin resistance or impaired insulin secretion. The rising prevalence of GDM underscores the need for improved diagnostic and management strategies. Fetuin-A, a glycoprotein involved in metabolic regulation and inflammation, has been implicated as a potential biomarker for GDM. </p> Objective <p>This meta-analysis evaluates the association between serum fetuin-A levels and GDM, examining its potential as a biomarker for diagnosis and risk stratification.</p> Methods <p>A systematic search of PubMed was conducted using relevant keywords, adhering to PRISMA guidelines. Eight studies, including 970 participants (478 GDM, 492 controls), met the inclusion criteria. Serum fetuin-A levels were compared using a random-effects model. Heterogeneity was assessed using the <i>I</i>² statistic, and publication bias was evaluated via funnel plots.</p> Results <p>The pooled standardized mean difference (SMD) for serum fetuin-A levels was 1.82 (95% CI − 1.18 to 4.83, <i>p</i> = 0.23), indicating an insignificant increase in the GDM group. Significant heterogeneity (<i>I</i>² = 96.97%) was observed, potentially due to differences in study populations, diagnostic criteria, and methodologies. Some studies reported positive associations between fetuin-A levels and GDM, while others observed negative or negligible correlations.</p> Conclusion <p>This meta-analysis concludes that serum fetuin-A levels in GDM are insignificantly increased. Given the high heterogeneity, further well-designed, large-scale studies are required to clarify the potential role of fetuin-A in GDM. Clinical implementation is not warranted based on current evidence.</p>