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

Table 1 Summary of diagnostic thresholds for gestational diabetes mellitus according to different guidelines

Guideline	Test type	Timing	Fasting threshold (mg/dL)	1-hour	2-hour	Diagnosis criteria
IADPSG	75-g OGTT	24-28 weeks	≥ 92	≥ 180	≥ 153	Any one abnormal
ADA	75-g OGTT	24-28 weeks	≥ 95	≥ 180	≥ 155	Any two abnormal
ACOG	50-g GCT + 100-g OGTT	24-28 weeks	≥ 95	≥ 180	≥ 155	Two-step approach
WHO	75-g OGTT	24-28 weeks	≥ 92	-	≥ 153	Any one abnormal

Thresholds are presented in both mmol/L and mg/dL. A diagnosis of gestational diabetes mellitus is established when one or more values exceed the cut-off in the one-step approach, or when two or more values exceed the cut-offs in the two-step approach. ADA: American diabetes association; IADPSG: International Association of Diabetes and Pregnancy Study Groups; ACOG: American College of Obstetricians and Gynecologists; WHO: World Health Organization; OGTT: Oral glucose tolerance test; GCT: Glucose challenge test.

Table 2 Risk stratification framework for gestational diabetes mellitus screening

Risk level	Key characteristics	Recommended screening approach
High	BMI ≥ 30 kg/m², prior GDM, strong family history, PCOS	Early OGTT (< 20 weeks), repeat at 24-28 weeks
Moderate	BMI 25-29.9 kg/m², age ≥ 30 years, non-White ethnicity	Standard OGTT at 24-28 weeks
Low	BMI < 25 kg/m², age < 25 years, no risk factors	Routine screening or selective as per policy

High-risk individuals may benefit from early screening, ideally before 24 weeks of gestation, to enable timely diagnosis and intervention. BMI: Body mass index; GDM: Gestational diabetes mellitus; PCOS: Polycystic ovary syndrome; OGTT: Oral glucose tolerance test.

Table 3 Glycemic targets for pregnant women according to American Diabetes Association 2024 guidelines

Time point	Target glucose (mg/dL)
Fasting	< 95
1 hour postprandial	< 140
2 hours postprandial	< 120

Values are based on capillary whole blood or plasma glucose measurements.

Table 4 Multilevel policy recommendations for the prevention and management of gestational diabetes mellitus

Level	Strategic action
Preconception	Promote weight optimization and screen high-risk women[2]
Antenatal	Implement universal OGTT screening in high-burden regions[14]
Postpartum	Ensure OGTT follow-up, breastfeeding support, and metabolic surveillance[44]
Health system	Harmonize diagnostic criteria and integrate GDM into chronic disease frameworks[6]

This table outlines strategic interventions across each stage of care, reinforcing the importance of aligning clinical guidelines with public health infrastructure to reduce the lifelong burden of gestational diabetes mellitus. GDM: Gestational diabetes mellitus; OGTT: Oral glucose tolerance test.

Table 5 Comparative overview of maternal and offspring risks associated with gestational diabetes mellitus

Risk domain	Maternal impact	Offspring impact
T2DM	7- to 10-fold increased risk within 10 years	Increased insulin resistance
Cardiovascular disease	A 2-fold increased risk (even without T2DM)	Early-onset CVD, hypertension
Weight trajectory	Higher postpartum weight retention	Higher adiposity and central fat distribution
Epigenetic programming	Persistent inflammation, β-cell stress	Altered methylation of insulin signaling genes
Preventive leverage	Breastfeeding, early screening	Healthy lifestyle education, pediatric monitoring

This table summarizes the long-term health risks faced by women with a history of gestational diabetes mellitus and their offspring, highlighting key domains such as diabetes, cardiovascular disease, obesity trajectories, epigenetic programming, and preventive opportunities. T2DM: Type 2 diabetes mellitus; CVD: Cardiovascular disease.

Table 6 Summary of clinical recommendations for gestational diabetes mellitus management across the care continuum

Domain	Clinical recommendation
Prenatal care	Integrate structured lifestyle guidance into routine visits
Screening	Employ early risk-based screening using BMI, age, ethnicity, and history
Postpartum	Ensure OGTT at 6-12 weeks and initiate annual T2DM risk surveillance
Education	Improve cultural and psychosocial sensitivity in patient communication
Health systems	Standardize GDM diagnosis globally; expand access and continuity of care

This framework synthesizes key action points for optimizing gestational diabetes mellitus management at every stage—from early detection to postnatal transition—anchored in prevention, personalization, and system-wide integration. GDM: Gestational diabetes mellitus; OGTT: Oral glucose tolerance test; T2DM: Type 2 diabetes mellitus.

Table 7 Summary of clinical strategies for preventing gestational diabetes mellitus recurrence

Strategy	Effectiveness	Comments
Preconception lifestyle	++	Strongest evidence, cost-effective
Mid-late pregnancy lifestyle	-	Typically implemented too late for meaningful metabolic benefit
Metformin	-	No proven preventive effect
Probiotics	-	Promising but inconsistent
Bariatric surgery	+++	Consider for BMI ≥ 35 kg/m² and failed lifestyle efforts

Effectiveness ratings are qualitative (+ to +++), based on current clinical trial data and expert consensus. BMI: Body mass index.

Table 8 Summary of key clinical and research dimensions in gestational diabetes mellitus

Dimension	Current standard	Controversies	Recommended research
Screening timing	24-28 weeks OGTT	Early screening utility unclear	TOBOGM and similar RCTs
Pharmacologic treatment	Insulin; Metformin (optional)	Long-term safety of metformin	Childhood follow-up & mechanistic studies
Epigenetics	Not routinely applied	Inconsistent miRNA & methylation data	Multicenter validation & standardization

This visual framework synthesizes current clinical guidelines, areas of uncertainty, and priorities for future research across critical domains in gestational diabetes mellitus care. OGTT: Oral glucose tolerance test; RCTs: Randomized controlled trials.