Gestational diabetes mellitus: Bridging research gaps through a translational framework

Gestational diabetes mellitus (GDM) is an increasingly prevalent metabolic disorder with profound implications for maternal and offspring health; however, it remains under-recognized compared with other forms of diabetes, particularly in low- and middle-income countries such as India. Once considered a transient pregnancy complication, GDM is now recognized as a manifestation of underlying insulin resistance, β-cell dysfunction, and metabolic vulnerability, conferring a markedly increased risk of future type 2 diabetes mellitus and the intergenerational transmission of metabolic disease. This narrative review critically examines the current understanding of the pathophysiology, diagnosis, and management of GDM, highlighting major gaps across the continuum of care. Persistent heterogeneity in diagnostic criteria, reliance on glucose-centric screening, inadequate community sensitization, and limited postpartum follow-up undermine effective detection and long-term prevention. Emerging insights into inflammatory pathways, adipokine imbalance, placental dysfunction, and epigenetic regulation highlight the importance of developing integrative mechanistic approaches. To address these challenges, a 360° hub-and-spoke translational framework is proposed, linking community engagement, standardized diagnosis, mechanistic research, and sustained postpartum care to reframe GDM as a life-course metabolic disorder.