Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2025; 13(29): 111096
Published online Oct 16, 2025. doi: 10.12998/wjcc.v13.i29.111096
Life-course management of gestational diabetes mellitus: A narrative review
Qing-Jing Luo, Qiang Ni
Qing-Jing Luo, Qiang Ni, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Qing-Jing Luo, Qiang Ni, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
Author contributions: Luo QJ and Ni Q designed the research study; Luo QJ conducted the literature review and drafted the manuscript; Ni Q supervised the study, critically revised the manuscript, and approved the final version.
Conflict-of-interest statement: All the authors declare that they have no conflicts of interest related to this work.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Check-list.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qiang Ni, Researcher, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 17 Section 3, Renmin South Road, Chengdu 610041, Sichuan Province, China. 18581843156@163.com
Received: June 23, 2025
Revised: July 5, 2025
Accepted: August 13, 2025
Published online: October 16, 2025
Processing time: 66 Days and 16.8 Hours
Abstract
BACKGROUND

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.

AIM

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

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: Gestational diabetes mellitus; Insulin resistance; Pregnancy; Fetal programming; Type 2 diabetes mellitus; Precision medicine; Epigenetics; Postpartum follow-up; Life-course management; Public health

Core Tip: This narrative review explores the latest evidence on gestational diabetes mellitus (GDM), emphasizing its pathophysiology, clinical management, and long-term cardiometabolic consequences. It highlights the role of early hyperglycemia, epigenetic fetal programming, and GDM heterogeneity. The review advocates for precision medicine, life-course management, and context-sensitive postpartum care. It also outlines structural barriers to follow-up in low-resource settings and provides a roadmap for individualized prevention strategies aimed at interrupting intergenerational disease transmission.