Gestational diabetes is defined as any degree of glucose intolerance first detected in pregnancy. The exact prevalence is difficult to determine in sub-Saharan Africa because the various studies on gestational diabetes mellitus did not use the same criteria. The sub-Saharan Africa has some peculiar challenges with addressing the burden of gestational diabetes in the region. This review aims to highlight some of these unique challenges. There are no universal criteria for the screening and diagnosis of gestational diabetes mellitus which is a challenge for health care providers and researchers in the region. The mainstay of treatment of gestational diabetes mellitus is lifestyle modification. There are insufficient trained dieticians and health educators to undertake this task in the region. Provision of health care for this category of patients is suboptimal in the region. Cost of health care and medications are mostly unaffordable thereby mitigating against optimal care of gestational diabetes mellitus in sub- Saharan Africa. The short term and long term complications of gestational diabetes mellitus to the mother and child are additional burden to the health care delivery systems in the region considering that the prevalence of gestational diabetes mellitus is rising in the region.