Pregnancy unmasks an underlying disposition for metabolic dysfunction. Women with GDM have chronic beta cell dysfunction which is present before and after gestation. These women are 7 times more likely to develop type 2 diabetes compared to those without a history of GDM. In addition, they are 2-4 times as likely to develop metabolic syndrome and twice as likely to develop cardiovascular disease. This talk also discusses strategies for minimising the risk and impact of these chronic conditions in women with a history of GDM. These strategies include improved screening for type 2 diabetes, risk stratification, diet and exercise, pharmacological measures such as metformin, and breastfeeding.