Gestational diabetes is a condition that complicates 0.15% to 12.3% of pregnancies, with wide variation in the incidence of gestational diabetes reported among ethnic groups. When gestational diabetes occurs, health implications occur for the mother and infant not only during pregnancy and birth but for the long term as well. This article reviews what is known about gestational diabetes and presents an overview of carbohydrate metabolism in normal pregnancies and those complicated by gestational diabetes. A review of recent research and advances in the field focusing on the screening, diagnosis, and treatment of gestational diabetes is also provided. The most important aspect of gestational diabetes management is client participation. Recommended education and counseling for women with gestational diabetes is discussed for pregnancy, labor and birth, postpartum, and long-term follow-up. Although medical consultation is necessary in these pregnancies, many nurse-midwives continue to provide care for women with gestational diabetes. Appropriate nurse-midwifery management of women with gestational diabetes is emphasized.