Gestational diabetes mellitus (GDM) is an emerging public health concern in sub-Saharan Africa (SSA), occurring in the context of rapid urbanization, nutritional transition, lifestyle changes, and underlying metabolic susceptibility. GDM also provides an important opportunity to identify women at increased risk of future type 2 diabetes mellitus (T2DM), although postpartum follow-up remains inadequate.

A narrative review of literature published from March 2010 to June 2026 was conducted using PubMed/MEDLINE, Scopus, Embase, Cochrane Library, and Google Scholar. Evidence on GDM epidemiology, diagnostic heterogeneity, metabolic mechanisms, β-cell dysfunction, postpartum progression to T2DM, and health-system approaches to postpartum prevention was synthesized, with particular emphasis on SSA and populations of African ancestry.

Reported GDM prevalence in SSA varies substantially according to diagnostic criteria, screening strategies, and study populations. Evidence from populations of African ancestry suggests that impaired β-cell secretory capacity may contribute importantly to dysglycaemia, including in individuals without marked obesity. Pregnancy-related metabolic stress may further expose this limited β-cell reserve. However, direct longitudinal evidence demonstrating accelerated progression from GDM to T2DM in SSA remains limited. Postpartum glucose testing and long-term follow-up are also suboptimal, resulting in missed opportunities for early identification and prevention.

The GDM-to-T2DM continuum in SSA requires greater attention to both biological susceptibility and health-system barriers. Harmonized diagnostic approaches, integrating postpartum metabolic screening into maternal and child health services, task shifting, and well-evaluated mHealth strategies may improve continuity of care and strengthen postpartum diabetes prevention.