There is emerging evidence that gestational diabetes mellitus (GDM) increases the risk of multi-system long-term complications such as cancer and autoimmune disease, however this evidence is scarce and conflicting. Therefore, we aim to explore the long-term health implications of GDM. We performed analyses using TriNetX in women≥18years who had a birth. Four cohorts were generated with a reference and GDM arm, and PSM 1:1 for factors including age, BMI, and cohort-specific risk factors. The cohort sizes were metabolic n=72,014, cancer n=88,131, autoimmune n=96,110, and gynaecological n=94,945. GDM increased the risk of 5-year incident clinical outcomes: metabolic: T2D (HR 18.42, p<0.0001), hypertriglyceridemia (HR 2.47, p<0.0001), obesity (HR 1.89, p<0.0001), and sleep apnoea (HR 1.83, p<0.0001); cancer: thyroid cancer (HR 1.34, p=0.036); autoimmune: type 1 diabetes (HR 12.32, p<0.001), Grave's disease (HR 1.57, p=<0.0001), and psoriasis (HR 1.25, p=0.007); and gynaecological PCOS (HR 1.97, p<0.0001), uterine fibroids (HR 1.29, p<0.0001), and endometriosis (HR 1.16, p=0.018). At 10years, there was a significantly increased risk of the composite 13 adiposity-related cancers (HR 1.18, p=0.008). Women with GDM are at risk of a myriad of long-term adverse health outcomes meriting targeted early intervention and long-term post-partum monitoring.

High intrapancreatic fat deposition (IPFD), or fatty pancreas disease (FPD), has been increasingly recognized as a major driver in the pathogenesis of type 2 diabetes mellitus (T2DM). This meta-analysis aims to quantify the prevalence of FPD in people with T2DM. We searched PubMed and Embase databases until October 27, 2025, for observational studies that reported data on FPD prevalence in people with T2DM. A generalized linear mixed model was used to estimate pooled prevalence. In total, 12 studies (6,369 individuals) were included. The pooled prevalence of FPD in T2DM was 54.28% (95% CI 37.70 to 69.96). Subgroup analyses indicated that the prevalence of FPD tended to be lower in Asian than European studies (42.85% vs. 69.19%, p=0.06) and was higher in smaller studies (<100 individuals: 67.55%) and in clinic/hospital-based settings (57.90%). No significant differences were observed in the prevalence of FPD when stratified by IPFD measurement method or median study year of enrollment. Approximately half of patients with T2DM have concomitant FPD, indicating a substantial yet underrecognized metabolic burden. These findings call for multidisciplinary efforts to better define the role of IPFD within the T2DM phenotype and to develop strategies for the prevention and monitoring of FPD in this population.