Pregnancy is a ‘stress test’ for the carbohydrate metabolism of all mothers-to be. This is due to a significant increase in anti-insulin action by the placental hormones. The resulting increase of maternal insulin resistance requires a high compensatory rise of maternal insulin secretion; which when inadequate to meet the demand, manifests as gestational diabetes (GDM). Diabetes in pregnancy can be broadly divided into pre-gestational or type 2 diabetes (T2DM) and GDM. Although two distinct clinical conditions, they are a part of the continual process towards the development of T2DM and cardiovascular disease (CVD) risks in the lifecycle of a woman. Therefore GDM is now viewed as a good predictor of future diabetes in a given population. Furthermore, the offspring of mothers with poorly controlled diabetes are at greater risk of obesity and premature metabolic derangement (an intergenerational effect).