Background: Gestational Diabetes Mellitus (GDM) is a common pregnancy complication linked to higher perinatal risks for mother and baby. Elevated serum uric acid levels can contribute to insulin resistance by inhibiting the insulin-mediated release of endothelial nitric oxide and directly impacting the adipocytes. During the first trimester, serum uric acid levels are similar to pre-conception levels, so increased levels may signal a higher GDM risk. Objective: Our study was conducted to analyse the relationship between first-trimester serum uric acid levels and the development of GDM. Additionally, we sought to evaluate the potential of elevated serum uric acid as an early predictor of GDM. Methods: This prospective observational study recruited eligible antenatal women with live singleton pregnancies and a gestational age of less than 15 weeks who attended the outpatient clinic using convenience sampling. Pregnant women with a gestational age above 15 weeks, overt diabetes mellitus, those taking steroids in any form, or consuming drugs known to increase serum uric acid levels, as well as women with gout, other endocrine disorders, chronic renal disease, liver disease, cardiovascular disorders, or who smoked, were excluded. Blood tests were conducted, and serum uric acid levels exceeding 3.5 mg/dL were regarded as elevated. The study participants underwent an oral glucose tolerance test (OGTT) between 24 and 28 weeks of gestation. GDM was diagnosed according to the criteria of the Diabetes in Pregnancy Study Group India (DIPSI). A statistical analysis was performed, including measures of diagnostic performance. Results: One hundred and eight antenatal women participated in the study, with a mean age of 23.6 (± 4.08) years. Most women (46.3%) were aged 21 to 25, and the majority (56.5%) were primigravida. The prevalence of GDM in this group was 19.4% (21/108). A univariate analysis was performed to investigate the relationship between serum uric acid levels and various factors. Women with first-trimester serum uric acid levels exceeding 3.5 mg/dL demonstrated a significant (p < 0.001) correlation with abnormal OGTT results. The diagnostic performance tests for elevated first-trimester serum uric acid levels in predicting GDM revealed a sensitivity of 90.5% and a negative predictive value of 97.1%. Conclusion: We concluded that elevated serum uric acid in the first trimester is linked to a higher risk of developing GDM and may serve as a screening tool for early identification.