Gestational diabetes mellitus (GDM) is a form of glucose intolerance that is first recognized during pregnancy. It occurs when hormonal changes associated with pregnancy interfere with insulin action, leading to elevated blood glucose levels. Although gestational diabetes usually resolves after delivery, it has important implications for both maternal and fetal health and increases long-term metabolic risk for the mother.

During pregnancy, placental hormones such as human placental lactogen induce physiological insulin resistance to ensure adequate glucose supply to the growing fetus. In some women, the pancreas is unable to compensate by increasing insulin secretion, resulting in gestational diabetes. Risk factors include obesity, advanced maternal age, family history of diabetes, previous gestational diabetes, polycystic ovary syndrome, and belonging to high-risk ethnic populations, including those in the Middle East.

Gestational diabetes is often asymptomatic and detected through routine screening, typically between 24 and 28 weeks of gestation. Screening involves glucose challenge testing or oral glucose tolerance testing. Early identification is critical, as untreated gestational diabetes increases the risk of pregnancy complications such as preeclampsia, polyhydramnios, preterm delivery, and operative delivery.

For the fetus, poorly controlled gestational diabetes can lead to excessive birth weight (macrosomia), shoulder dystocia during delivery, neonatal hypoglycemia, respiratory distress, and increased risk of obesity and Type 2 diabetes later in life. These risks highlight the importance of tight glucose control throughout pregnancy.

Management of gestational diabetes focuses on maintaining blood glucose levels within target ranges to ensure optimal maternal and fetal outcomes. Nutritional therapy is the cornerstone of treatment, emphasizing balanced meals, controlled carbohydrate intake, and appropriate calorie distribution across the day. Regular physical activity, when medically appropriate, improves insulin sensitivity and glucose utilization.

Blood glucose monitoring is essential, allowing timely adjustments in diet or treatment. If lifestyle measures are insufficient, insulin therapy may be required, as it is safe and effective during pregnancy. In selected cases, oral glucose-lowering medications may be considered under specialist supervision.

Close collaboration between obstetricians, endocrinologists, dietitians, and diabetes educators is essential for comprehensive care. Fetal growth and maternal health are monitored closely throughout pregnancy.

After delivery, blood glucose levels usually normalize; however, women with gestational diabetes remain at significantly increased risk of developing Type 2 diabetes in the future. Postpartum glucose testing and long-term lifestyle modification are therefore critical components of care. With early diagnosis and structured management, gestational diabetes can be effectively controlled, ensuring healthy pregnancy outcomes and long-term metabolic health.