Overweight and obese women are at a higher risk for gestational diabetes mellitus. The gut microbiome could modulate metabolic health and may affect insulin resistance and lipid metabolism. The aim of this study was to reveal relationships between gut microbiome composition and circulating metabolic hormones in overweight and obese pregnant women at 16 weeks' gestation. Fecal microbiota profiles from overweight (n = 29) and obese (n = 41) pregnant women were assessed by 16S rRNA sequencing. Fasting metabolic hormone (insulin, C-peptide, glucagon, incretin, and adipokine) concentrations were measured using multiplex ELISA. Metabolic hormone levels as well as microbiome profiles differed between overweight and obese women. Furthermore, changes in some metabolic hormone levels were correlated with alterations in the relative abundance of specific microbes. Adipokine levels were strongly correlated with Ruminococcaceae and Lachnospiraceae, which are dominant families in energy metabolism. Insulin was positively correlated with the genus Collinsella. Gastrointestinal polypeptide was positively correlated with the genus Coprococcus but negatively with family Ruminococcaceae. This study shows novel relationships between gut microbiome composition and the metabolic hormonal environment in overweight and obese pregnant women at 16 weeks' gestation. These results suggest that manipulation of the gut microbiome composition may influence pregnancy metabolism.The increasing prevalence of maternal obesity and its subsequent health outcomes are a significant public health concern and a major challenge for obstetrics practice. In early pregnancy, overweight and obese women are at an increased risk of metabolic complications that affect placental and embryonic development (1). Metabolic adjustments, such as a decline in insulin sensitivity and an increase in nutrient absorption, are necessary to support a healthy pregnancy (2,3); however, these metabolic changes occur on top of preexisting higher levels of insulin resistance in overweight and obese pregnant women, increasing the risk of overt hyperglycemia because of a lack of sufficient insulin secretion to compensate for the increased insulin resistance (3).The potential role of the gut microbiome (the composite of the bacteria present in the gastrointestinal tract) in pregnancy has become the subject of considerable interest. In normal pregnancy, the maternal gut microbiota changes from first to third trimester with a decline in butyrate-producing bacteria and an increase in Bifidobacteria, Proteobacteria, and lactic acid-producing bacteria. Inflammation and weight gain that occurs during pregnancy might be the result of microbe-driven processes to increase energy supply for the fetus (4). These alterations might also be linked with the maternal metabolic profile and thereby contribute to the development of pregnancy complications (5,6) as well as affect the metabolic and immunological health of the offspring (7). In summation, modifications in the metabolic hormone milieu du...