Life-course management of gestational diabetes mellitus: A narrative review

Gestational diabetes mellitus (GDM) has emerged as a global public health challenge, fueled by increasing maternal age, rising obesity rates, and lifestyle shifts. It is linked to substantial short- and long-term health risks for both mothers and their offspring, offering a critical opportunity for intergenerational prevention of metabolic disorders.

To synthesize current evidence on the pathophysiology, diagnosis, management, complications, and individualized treatment strategies of GDM.

We conducted a narrative review in accordance with PRISMA guidelines. PubMed, Scopus, Web of Science, and EMBASE were searched for English-language articles (2017-2025) using terms such as "GDM", "pregnancy", "insulin resistance", and "maternal outcomes". After removing duplicates, 512 records were screened; 102 full texts were assessed for eligibility, and 55 studies were included based on methodological quality, clinical relevance, and alignment with the review objectives.

GDM results from a complex interplay among progressive insulin resistance, β-cell dysfunction, immune dysregulation, and placental inflammation. Emerging evidence indicates that hyperglycemia before formal diagnosis can impair fetal programming via epigenetic mechanisms. GDM increases a mother's risk of developing type 2 diabetes mellitus seven- to tenfold and raises the incidence of cardiovascular disease, preeclampsia, and cesarean delivery. Offspring are at higher risk of macrosomia, neonatal hypoglycemia, and future metabolic and cardiovascular disorders. Lifestyle modification remains the cornerstone of therapy and, when necessary, can be supplemented with pharmacologic agents such as metformin or insulin. Postpartum follow-up, breastfeeding support, and preconception counseling are vital to long-term metabolic health.

GDM requires precision-based, life-course care. Future priorities include early risk detection, biomarker validation, unified diagnosis, and culturally sensitive interventions to improve maternal-child outcomes.