OBJECTIVE: The purpose of this study was to examine pregravid cardiometabolic profile and subsequent risk of gestational diabetes mellitus (GDM). STUDY DESIGN: GDM cases (n = 199) and control subjects (n = 381) were selected from a cohort of women who took part in a multiphasic health checkup examination at Kaiser Permanente from 1984-1996 and who had a subsequent pregnancy and were matched by year and age at multiphasic health checkup examination and age at delivery. RESULTS: Pregravid measurements of serum glucose levels of 100-140 mg/dL, body mass index of >/=25.0 kg/m(2), and prehypertension/hypertension level were associated independently with GDM risk (odds ratios [OR], 4.8; 95% confidence interval [CI], 1.7-13.9; OR, 2.7; 95% CI, 1.6-4.3; and OR, 1.5; 95% CI, 1.0-2.3, respectively). The risk of GDM increased with the number of cardiometabolic risk factors (P < .001); adverse levels of both body mass index and glucose were associated with a 4.6-fold increased risk of GDM, compared with women with normal levels (P = .0001). CONCLUSION: Pregravid cardiometabolic risk profile may help clinicians to identify high-risk women to target for primary prevention or early management of GDM.