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

Figure 7 Life-course impact of gestational diabetes mellitus. This schematic illustrates the parallel health trajectories of mothers and their offspring following exposure to gestational diabetes mellitus (GDM). Maternal risks include progression to type 2 diabetes mellitus (T2DM) [relative risk (RR) = 7-10], cardiovascular disease (RR = 1.98), and NAFLD. Offspring face increased risks of neonatal complications, childhood obesity (54% higher), insulin resistance, and adult-onset cardiovascular disease (RR = 1.42). Central drivers include DOHaD-based fetal programming, persistent epigenetic alterations, and transgenerational metabolic stress. Blue blocks: Maternal life stages (GDM → postpartum → T2DM/CVD/NAFLD). Orange blocks: Offspring trajectory (neonatal → childhood → adult metabolic disease). Purple blocks: Epigenetic memory (e.g., increased LEP methylation, decreased miR-29a, and increased miR-98). Light-purple blocks: DOHaD hypothesis - epigenetic basis of lifelong risk. Gray box: Quantified risks - e.g., +54% childhood obesity; T2DM RR: 7-10 ×. RR: Relative risk; T2DM: Type 2 diabetes mellitus; CVD: Cardiovascular disease; NAFLD: Non-alcoholic fatty liver disease; DOHaD: Developmental Origins of Health and Disease; LEP: Leptin; miR: MicroRNA.