Background Rising of gestational diabetes (GD) incidence along with obesity, leads to increasing both pregnancy and neonatal complications. In utero exposure to hyperglycaemia increases the risk of future obesity and type 2 diabetes development. The aim was to evaluate influence of metabolic disorders and body mass index (BMI) in women with GD on the risk of diabetic fetopathy development in their newborns. Materials and methods Monocentric, ambispective, observational study was conducted at Tertiary Perinatal Centre, Irkutsk, Russia, between January 2018 and January 2019. It included 34 newborns from mothers with GD. Inclusion criterion was confirmed GD in the mother. Pregnancy complications, perinatal outcomes in diabetic mothers and their newborns follow-up data were collected and analyzed. Results At birth, mean weight was 2647 grams (IQR 920–4420). Mean gestational age was 38 weeks (IQR 27–41). Among newborns, 52.9% was premature and 5.8% was small for gestational age. Symptomatic diabetic fetopathy (DF) was revealed in 17 infants (DF group), and 17 infants did not have DF (controls). Mothers of newborns with fetopathy were tested on GD at 31 (IQR 30–32) week of pregnancy, and mothers of controls (p=1.0) – at 25 (IQR 20–30) week. It was found that mothers of newborns with DF 6 times oftener had an elevated BMI at first pregnancy consultation than mothers of controls - 12 vs 2, respectively (OR = 3.4; 95% CI: 1.2–5.5), and they had excessive weight gain during pregnancy 3.5 times oftener than those without DF - 14 vs 4 (OR = 4.1; 95% CI: 1.0–6.7), respectively. GD was associated with hypertensive disorders of pregnancy (including pre-eclampsia, pregnancy-induced hypertension) in most mothers of DF group, comparing to controls (82.3% versus 47%; p=0.03). Ultrasonography detected excessive growth of the fetus (11.7%; p=0.2) and polyhydramnios (29.4%; p=0.3) in mothers of DF group. Mothers of DF group had caesarean sections 5 times oftener than mothers of controls: 10 vs 2 (p=0.004), respectively. Macrosomia, neonatal hypoglycaemia and hypocalcaemia were common symptoms among DF newborns compared with controls: 47% vs 11.7% (p=0.02), 100% vs 0 (pConclusions We showed that metabolic disorders, high baseline BMI during pregnancy, and late GD detection in diabetic mothers are leading causes of poor perinatal outcomes and symptomatic DF in infants. Implementation of GD screening program, informing about baseline metabolic disorders in women and baseline BMI during pregnancy can prevent both maternal and infant health outcomes.