Gestational diabetes mellitus (GDM) and its associated complication, macrosomia, pose significant challenges during pregnancy. This review explores the epidemiological aspects, pathophysiology, complications, and long-term consequences of these conditions, with a focus on the need for early detection and advanced management strategies. The prevalence of GDM varies globally, with particular attention to India, where the correlation between macrosomia and GDM is evident. Early prenatal monitoring and glycemic control have been identified as effective strategies to reduce macrosomia incidence. Understanding the pathophysiology of GDM reveals a complex interplay of β-cell dysfunction and chronic insulin resistance, resulting in elevated blood sugar levels. This disruption contributes to macrosomia, characterized by the birth of abnormally large infants. Complications associated with macrosomia are not limited to childbirth; mothers may experience protracted labor, uterine atony, and an increased risk of tears, while newborns face the challenge of shoulder dystocia and neonatal jaundice. Additionally, the enduring significance of exposure to GDM in utero is concerning, with evidence linking it to childhood obesity and metabolic syndrome. The review also discusses promising research directions. The study of glycation markers aims to improve macrosomia prediction, enabling better management and care for affected pregnancies. Moreover, the integration of mobile technology, such as the GDm health smartphone solution, offers remote monitoring of blood glucose levels and tailored feedback, potentially revolutionizing GDM management. In tackling the challenges presented by GDM and macrosomia, a multifaceted approach is essential. Early and effective prenatal care, coupled with vigilant glycemic control, is critical for the well-being of both mothers and their infants. Continued research into innovative screening and management methods will further enhance pregnancy outcomes and long-term health. Healthcare professionals, armed with a comprehensive understanding of these conditions and their extensive effects, play a pivotal role in supporting expectant mothers and ensuring a brighter and healthier future for both mother and child.