The purpose of this study was to examine pregravid cardiometabolic profile and subsequent risk of gestational diabetes mellitus (GDM).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.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).Pregravid cardiometabolic risk profile may help clinicians to identify high-risk women to target for primary prevention or early management of GDM.