Objective — to assess the specific features of early postnatal adaptation and to optimize the management of neonates born to mothers with gestational diabetes mellitus (GDM). Subject and methods. A total of 250 newborn babies born to mothers with GDM, among whom 100 infants had been examined in 2013—2014 prospectively and 150 had been examined in 2002—2012 retrospectively, were examined using the history data of the neonates. Their mothers during pregnancy had undergone an oral glucose tolerance test and glycemia control. The neonates underwent physical, laboratory, and instrumental studies. According to the degree of central nervous system (CNS) involvement, the infants were divided into 4 groups: A) 138 babies had no signs of CNS involvement; B) 57 had mild perinatal CNS involvement; C) 21 had moderate CNS involvement; D) 34 with severe CNS involvement. Results. Perinatal CNS involvement was the most common early adaptation complication in babies with diabetic fetopathy. The severity of dysadaptive processes was also affected by respiratory distress syndrome and metabolic and electrolyte disorders. Additions to an examination algorithm for newborn infants born to mothers with GDM and pathogenetically sound treatment and prevention measures were elaborated. Conclusion. The neonates born to mothers with GDM belong to a high-risk group of early postnatal dysadaptive processes. The timely detection of GDM in pregnant women, glycemic correction, and the elaborated supplemented examination algorithm and a pathogenetic approach to therapy could substantially reduce the rate of the severest postnatal dysadaptation in infants born to mothers with GDM. The authors declare no conflicts of interest.