Gestational diabetes mellitus (GDM) is associated with adverse maternal, fetal and perinatal complications. Without appropriate glucose management, women with GDM and their offspring have an increased risk of developing type 2 diabetes and other metabolic conditions later in life, thereby adding to the growing burden of non-communicable diseases (NCDs). This review provides an update of GDM in South Africa (SA), showing that its prevalence is increasing, and highlights treatment and management strategies currently employed. Although the increase in GDM prevalence may partly be due to less stringent diagnostic criteria, the role of the increasing obesogenic environment in SA is an additional factor. Future research should focus on reducing the rising obesity epidemic and in so doing aim to prevent the development of GDM in SA. Such initiatives will have a positive impact on decreasing maternal and child morbidity and mortality and the future burden of NCDs.