Objective To investigate the predictive value of serum nesfatin 1 (NSF-1), obestatin (OB) and glucagon-like peptide 1 (GLP-1) levels for the adverse pregnancy outcomes of patients with gestational diabetes mellitus (GDM).Methods From Jan. 2019 to Dec. 2020, 122 GDM women (GDM group) and 75 healthy pregnant women (normal pregnancy group) who visited our hospital were enrolled. The venous blood was collected to compare the levels of serum NSF-1, OB and GLP-1 in the 2 groups, and the relationship between the levels of serum NSF-1, OB and GLP-1 and the degree of blood glucose control in GDM patients was analyzed. Univariate and multivariate binary logistic regression analyses were performed in GDM patients with poor pregnancy outcomes, and ROC curves were drawn to evaluate the diagnostic efficacy of serum NSF-1, OB and GLP-1 levels in predicting poor pregnancy outcomes of GDM patients.Results The serum NSF-1 level in the GDM group was significantly higher than that in the normal pregnancy group (P < 0.01), and increased with the increase of gestational week and the improvement of blood glucose control (both P < 0.01). The serum levels of OB and GLP-1 were significantly lower in the GDM group (P < 0.01), and decreased with the increase of gestational week and the improvement of blood glucose control (all P < 0.01). The serum levels of glycosylated hemoglobin (HbA1c) and NSF-1 in the poor pregnancy outcome group were significantly higher than those in the good pregnancy outcome group (both P < 0.01), while the serum levels of OB and GLP-1 were significantly lower in the good pregnancy outcome group (both P < 0.01). Multivariate binary logistic regression analysis showed that the levels of serum NSF-1, OB and GLP-1 were independent prognostic factors of poor pregnancy outcomes (all P < 0.01). The serum levels of NSF-1, OB and GLP-1 had a higher diagnostic efficiency in predicting poor pregnancy outcomes of GDM patients. The sensitivity of the combined detection was 97.4%, specificity was 83.3% and AUC was 0.966, which was significantly higher than those of the single index (NSF-1[Z=4.078, P < 0.01], OB[Z=4.059, P < 0.05] and GLP-1[Z=2.918, P < 0.01]).Conclusion The levels of serum NSF-1, OB and GLP-1 in GDM patients are risk factors of poor pregnancy outcomes, and have high diagnostic efficiency in predicting poor pregnancy outcomes.