Gestational Diabetes in Somali Women: Neglected Risks for Maternal and Neonatal Health

This commentary examines gestational diabetes mellitus (GDM) as an under-recognised contributor to adverse maternal and neonatal outcomes among Somali women and in comparable fragile settings. GDM is associated with pre-eclampsia, macrosomia, obstructed labour, stillbirth, neonatal morbidity, and later type 2 diabetes in women and offspring. Globally, hyperglycaemia in pregnancy affects approximately one in six live births, yet detection and management remain least accessible in low-resource and conflict-affected settings. Somalia has high maternal and neonatal mortality, but local GDM prevalence data are not available and routine screening is rarely embedded in antenatal care. Drawing on WHO guidance, international evidence, and literature on Somali, East African, migrant, and humanitarian populations, we argue that GDM is made invisible by overlapping clinical, social, and health-system factors: early-life undernutrition, nutritional transition, high fertility, short birth intervals, limited antenatal access, weak diagnostic supply chains, low awareness of asymptomatic "sugar disease", and limited policy attention to pregnancy-related non-communicable diseases. These gaps convert a detectable and manageable condition into preventable complications, including obstructed labour, postpartum haemorrhage, hypertensive disorders, stillbirth, neonatal hypoglycaemia, and intergenerational diabetes risk. Practical responses include pragmatic risk-based or simplified glucose screening where oral glucose tolerance testing is not feasible, reliable access to glucometers and strips, midwife-led protocols, Somali-language education, engagement of families and community leaders while protecting women's autonomy, postpartum follow-up linked to immunisation and child-health contacts, and inclusion of GDM indicators in maternal health information systems. Recognising and addressing GDM is essential for reducing preventable maternal and neonatal harm and for strengthening equitable women's healthcare in fragile settings.