Background: Gestational diabetes mellitus (GDM) is a major contributor to short- and long term maternal and neonatal complications. GDM is still common in South Asian populations, with evidence suggesting high prevalence in Pakistan (18–25%). Objectives: The aim of this prospective cohort study was to examine the dynamics of serum ANGPTL8 in pregnancy, its relationship with insulin resistance (IR), and its utility as a marker for predicting postpartum metabolic health in Pakistani women. Methodology: a total of 150 pregnant women (75 with GDM, 75 as normoglycemic controls) recruited from two tertiary hospitals in urban Pakistan, and followed them through pregnancy. Trimesters 1 through 3, the women had their serum ANGPTL8 levels, IR markers (HOMA IR), and dietary intake patterns, as well as genetic variants (ANGPTL8 rs2278426), and socioeconomic status assessed. Follow-up assessments for dysglycemia and dyslipidaemia occurred at 6, 12, and 24 months after delivery. Results: Women with GDM had significantly higher (2.8 ± 0.9 ng/mL) ANGPTL8 levels especially in the third trimester (2.1 ± 0.7 ng/mL among controls; p < .001) and was strongly correlated with HOMA-IR (r = .62, p< .001). ANGPTL8 was independently associated with high-carbohydrate diets (β = 0.23, p = .004) and SNP (OR = 2.1, p < .001). In the postpartum period, third-trimester ANGPTL8 ≥ 2.5 ng/mL predicted dysglycemia (AUC = 0.84, 95% CI [0.78, 0.90]) with sensitivity and specificity of 82% and 76%, respectively. Low socioeconomic status compounded metabolic risk (HR = 1.8, p = .02). Conclusion: This study recognizes ANGPTL8 as potential and reliable biomarker for GDM severity and postpartum metabolic dysfunction in women, who come from Pakistan. The addition of ANGPTL8 screening to obstetric care and public health strategy may allow for early intervention in high-burden populations to reduce long-term risk for type 2 diabetes