OBJECTIVE This study assessed the association between first-trimester abdominal adiposity and dysglycemia and gestational diabetes mellitus (GDM) in midpregnancy. RESEARCH DESIGN AND METHODS In a prospective cohort of 485 women, we measured subcutaneous (SAT), visceral (VAT), and total (TAT) adipose tissue depth, using ultrasound at 11–14 weeks’ gestation. Logistic regression analysis assessed the relation between quartiles of SAT, VAT, or TAT depth and the composite outcome of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or GDM, based on a 75-g oral glucose tolerance test at 24–28 weeks. RESULTS Adjusting for maternal age, ethnicity, family history of diabetes, and BMI, quartile 4 versus quartile 1 VAT (adjusted odds ratio [aOR] 3.1, 95% CI 1.1–9.5) and TAT (aOR 2.7, 95% CI 1.1–7.8) were significantly associated with the composite outcome, but SAT was not (aOR 1.8, 95% CI 0.70–4.8). The same was seen for GDM alone. CONCLUSIONS Elevated first-trimester VAT and TAT depth independently predicted the risk of dysglycemia later in pregnancy.