ABSTRACT:
Executive Summary (Policy Brief Paper) Gestational diabetes mellitus (GDM) is an important contributor to maternal and neonatal morbidity in Africa. Available evidence indicates that approximately 14% of pregnancies in sub-Saharan Africa are affected, with country-level estimates ranging widely depending on population characteristics and diagnostic criteria used. Rising obesity, advancing maternal age, family history of diabetes, and prior GDM are consistently identified risk factors, while health system constraints limit early detection and effective management, contributing to poor outcomes. Findings from the systematic review indicate marked variation in screening and diagnostic practices. Many countries continue to use selective and risk-based screening rather than universal oral glucose tolerance testing OGTT, leading to underdiagnosis and missed opportunities to prevent adverse outcomes. GDM is strongly associated with macrosomia, preeclampsia, stillbirth, and higher rates of caesarean delivery, and in the long term, higher risks of type 2 diabetes and obesity in both mothers and their children. Evidence further shows that improved glycaemic control through lifestyle modification and pharmacologic treatment can significantly reduce these risks. Insights from the bibliometric analysis reveal uneven research productivity concentrated in a limited number of African countries and institutions, weak cross-country collaboration, and notable gaps in longitudinal and implementation focused studies. These patterns highlight the need for coordinated investment and stronger policy engagement to translate evidence into practice. Priority policy actions include: • Standardising GDM screening and diagnostic guidelines within routine antenatal care • Strengthening prevention through nutrition, lifestyle, and preconception interventions • Expanding access to OGTT and essential medications, including insulin and metformin • Building health worker capacity and improving referral and follow up systems • Increasing funding for maternal health research and intra-African collaboration Implementing these evidence-informed actions provides a critical opportunity to reduce preventable maternal and neonatal complications and disrupt the intergenerational cycle of diabetes and obesity in Africa.