Abstract
Gestational diabetes mellitus (GDM) is one of the most prevalent metabolic complications of pregnancy, with incidence rising particularly sharply in low- and middle-income countries (LMICs). Despite bearing the greatest share of the global GDM burden, LMIC populations are substantially underrepresented in systematic reviews examining long-term maternal outcomes. This review aimed to synthesise available evidence on long-term maternal outcomes of GDM in LMIC settings, examine health system factors shaping postpartum detection and follow-up, and identify gaps relative to the broader global literature. A structured search of PubMed, Scopus, and Google Scholar was conducted following PRISMA 2020 guidelines. Eighteen peer-reviewed studies published between 2014 and 2024 — covering Ethiopia, sub-Saharan Africa, South Africa, India, Iran, and multi-country LMIC contexts — were included. Given methodological heterogeneity across study designs, populations, and outcome measures, a narrative synthesis approach was adopted. Four thematic domains emerged. First, postpartum progression to type 2 diabetes (T2D) and dysglycaemia was the most consistently documented outcome, with rapid conversion documented in South Asian and Ethiopian cohorts. Second, metabolic syndrome and cardiometabolic risk were measurably elevated as early as six to twelve weeks postpartum, with in-hospital glucose testing demonstrated to be an inadequate substitute for the recommended OGTT. Third, GDM burden across LMIC regions is substantially higher than current prevalence estimates suggest, due to the systematic inadequacy of risk-factor-based screening. Fourth, pervasive health system and diagnostic barriers — fragmented care transitions, personnel shortfalls, and absent postpartum follow-up pathways — render long-term GDM monitoring the exception rather than the rule. GDM in LMIC settings carries serious, predictable, and largely preventable long-term maternal health consequences that current health systems are not organised to detect or address. Integrating evidence-based postpartum surveillance and cardiometabolic monitoring into LMIC clinical and policy frameworks is both clinically essential and a matter of global health equity.