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Objective Gestational diabetes mellitus (GDM) is associated with adverse perinatal outcomes and is an independent risk factor for vaginal dysbiosis. Understanding the vaginal microbiota in health and disease is essential to screen, detect, and manage complications of pregnancy. Therefore, the aims of the present study were to assess and compare vaginal dysbiosis in pregnancy in women with and without GDM and examine its impact on perinatal outcomes in our population. Methods The present study was a prospective cohort study recruiting pregnant women. The subjects were divided into two groups (GDM and non‐GDM) and were followed until delivery to assess fetomaternal outcomes. Vaginal samples were collected at 24–28 weeks and 34–38 weeks for Nugent scoring and determination of bacterial and fungal species. Results The study recruited 502 pregnant women, with a final assessment of 320 mother–infant pairs (GDM n = 134; non‐GDM n = 186). We found a significant association of vaginal dysbiosis with GDM and adverse perinatal outcomes. Significant differences were also seen in status of infection and its trimester‐wise changes in relation to hyperglycemia. Conclusion By defining an association of vaginal dysbiosis with GDM and its correlation with perinatal outcomes, the present study calls for exploitation of this potential association as a new target in the prevention and treatment of GDM and in alleviating their undesired maternal and infant outcomes.

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