OBJECTIVE: To probe into the effects of insulin aspart combined with different courses of Bifidobacterium triple viable enteric capsule on insulin resistance, lipid metabolism and delivery outcomes in patients with gestational diabetes mellitus (GDM). METHODS: Totally 400 patients with GDM admitted into the hospital from Jan. 2021 to May 2023 were extracted to be divided into the group A, group B, group C and control group via the random number table method, with 100 cases in each group. The control group was treated with insulin aspart, the group A received insulin aspart combined with short-course Bifidobacterium triple viable enteric capsule (4 weeks), the group B was given insulin aspart combined with medium-course Bifidobacterium triple viable enteric capsule (8 weeks), and the group C was treated with insulin aspart combined with long-course Bifidobacterium triple viable enteric capsule (12 weeks). Changes of lipid metabolism, insulin resistance and delivery outcome were observed in four groups after treatment. RESULTS: After treatment, fasting blood glucose (FBG), 2 h blood glucose (2 hBG), fasting insulin (FINS), homeostatic model assessment of insulin resistance (HOMA-IR), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) in four groups were lower than those before treatment, and high-density lipoprotein cholesterol (HDL-C) was higher than those before treatment, with statistically significant differences (P<0. 05). Inter-group comparison showed that FINS, HOMA-IR, TG, TC, LDL-C in the group B and group C were lower than those in the group A and control group, HDL-C was higher than that in the group A and control group, with statistically significant differences (P < 0. 05). There was no statistically significant difference among four groups in FBG and 2 hBG (P> 0. 05). Difference in FINS, HOMA-IR, TG, TC, LDL-C between the group B and group C, the group A and control group were not statistically significant (P>0. 05). The incidence of poor pregnancy outcomes in control group, group A, group B and group C was respectively 41. 0% (41 / 100), 38. 0% (38 / 100), 15. 0% (15 / 100) and 17. 0% (17 / 100); the incidence of poor neonatal outcomes was respectively 42. 0% (42 / 100), 35. 0% (35 / 100), 13. 0% (13 / 100) and 14. 0% (14 / 100); compared with group A and control group, the incidence of poor pregnancy outcomes and neonatal outcomes in group B and group C was lower, with statistically significant difference (P<0. 05). CONCLUSIONS: There are some differences in insulin resistance, lipid metabolism and pregnancy outcome of patients with GDM with the same course of Bifidobacterium triple viable enteric capsule, among which 8 weeks of treatment is the best treatment course. [ABSTRACT FROM AUTHOR]