Background: To investigate the association between concentrations of total cholesterol (TC), at the time of gestational diabetes mellitus (GDM) diagnosis, and risk of postpartum impaired glucose tolerance. Methods: This is a retrospective cohort study. Women who were diagnosed GDM with a live singleton delivery between January 1 2013 and December 31 2017 were included in this study (n=2, 839). Women were grouped based on the TC quartiles at the time of GDM diagnosis, and relationship between TC and risk of postpartum glucose intolerance was assessed by COX regression. Findings: A total of 855 women were in the final analysis. Higher TC quartile at diagnosis of GDM was associated with a decreased risk of postpartum impaired glucose tolerance. Women in the highest TC quartile (>7·0 mmol L-1) had approximately only half-risk of any postpartum glucose intolerance, compared with women in the lowest TC quartile (<5·5 mmol L-1). Interpretation: The increased concentration of TC, at the time of GDM diagnosis, was related to a reduced risk of postpartum disorders of glucose metabolism in GDM women. We speculated that the increase of cholesterol may be a compensatory and adaptive response to pregnancy, and failure or deficiency to compensation may cause the occurrence of glucose metabolism disorders. Funding Statement: The study was supported by National Natural Science Foundation of China (Grant No: 81571452), Natural Science Foundation of Guangdong Province (Grant No: 2017A030310191), and Clinical Medical Project 5010 of Sun Yat-sen University, China (Grant No: 2012004). Declaration of Interests: No potential conflicts of interest relevant to this article were reported. Ethics Approval Statement: This study was approved by the Institutional Review Board of The First Affiliated Hospital of Sun Yat-sen University. All procedures were conducted in accordance with the Declaration of Helsinki.