Treating Maternal Hyperglycaemia in Gestational Diabetes Mellitus Without Addressing Maternal Pre-pregnancy Weight: A Case of “Shooting the Messenger”

Gestational diabetes mellitus (GDM) poses significant challenges in modern obstetrics, driving increased monitoring and intervention. Emerging evidence suggests that the embryo's exposure to maternal hyperglycaemia and the consequent hyperinsulinaemia, leading to epigenetic changes and accelerated foetal growth, occurs much earlier than the typical 24–28-week screening window. Early epigenetic changes are the determinants of future health. Current research, though, demonstrates a moderate maternal and foetal benefit in treating GDM; the available data are not supportive of the prevention of long-term cardiometabolic health risks in the offspring despite treatment in mid-trimester. Pre-pregnancy maternal body mass index (BMI) and excessive gestational weight gain are more potent predictors of higher birth weight and macrosomia than mid-trimester hyperglycaemia alone. While treating hyperglycaemia is essential, addressing pre-pregnancy maternal high BMI is equally important.