Approach to the patient after gestational diabetes mellitus: what's next?

The prevalence of gestational diabetes mellitus (GDM) continues to rise and is estimated to affect 14% of women worldwide. It is well established that early identification and treatment of GDM can improve maternal and fetal outcomes. While hyperglycemia typically resolves after delivery, metabolic risks to mother and offspring persist postpartum and continued surveillance is essential to prevent long-term complications. Women with prior GDM have increased risk of future type 2 diabetes (T2D), cardiovascular disease (CVD), and recurrence of GDM. There is evidence-based support for the prevention of diabetes following GDM, with both intensive lifestyle modification and metformin. Although specific data on how to decrease CVD risk in women with GDM are not currently available, it is prudent to apply general CVD recommendations to these women. Women with a history of GDM should have long-term monitoring and continued counseling, including family planning, with proactive approaches to reduce future risk of progression to diabetes and cardiovascular disease.