Precision Medicine and Shared Decision-Making to Advance Gestational Diabetes Management: Genetic, Metabolic, and Gut Microbiota Factors.

Despite the apparent heterogeneity of Gestational Diabetes Mellitus (GDM) and the inter-individual variation, the current management follows standardised protocols that do not account for patients' needs or underlying phenotypic differences. A search of peer-reviewed literature was conducted to focus on precision medicine (PM) and shared decision-making (SDM) approaches in GDM. A narrative synthesis of evidence from clinical studies, reviews, and conceptual frameworks was conducted to explore how integrating PM with SDM may contribute to more individualised, patient-centred GDM care. The Web of Science Core Collection (WoSCC) was searched to assess trends in publications over the past decade. Women with GDM exhibit diverse clinical trajectories and consistently report a desire to be involved in decisions affecting maternal and infant outcomes. PM enables further individualisation through genetic, metabolic, environmental, and emerging markers, including the gut microbiota, to refine risk stratification and guide targeted interventions. SDM supports informed, collaborative treatment choices and is associated with improved engagement, adherence, and satisfaction. Integrating PM and SDM offers a pathway toward truly individualised GDM care by aligning biologically tailored management with women's values and priorities. Combining SDM and PM may provide a more holistic framework for individualised GDM care. This framework could potentially enhance the effectiveness, acceptability, and sustainability of GDM management and may lead to a change in current practice. Despite their promise, both approaches remain underutilised and insufficiently integrated into current GDM care models.