Although clustering of cardiovascular risk factors is unquestionable, the importance of the "metabolic syndrome" as a distinct cardiovascular risk marker has been debated recently. In the authors' previous report a high frequency of glucose intolerance was described 8 years after a pregnancy complicated by gestational diabetes, often associated with other unfavorable metabolic parameters. In the present study the objective was to estimate the prevalence of metabolic syndrome in a cohort of previously gestational diabetes women, using different diagnostic criteria, 4 years after delivery. Those data were compared to a control group of 39 women with normal glucose tolerance during pregnancy. Irrespective of the criteria used, metabolic syndrome was found more frequently among women with prior gestational diabetes. The prevalence of metabolic syndrome increased by degree of deterioration of glucose tolerance in the prior gestational diabetes group. Overweight women in both group had 10-fold increased risk of metabolic syndrome compared to normal-weight women. According to our results a clustering of cardiovascular risk factors might be observed in previous gestational diabetes women, 4 yrs after delivery. These data highlight the importance of regular follow-up of these women, and the possible advantage of early and aggressive treatment of each component of metabolic syndrome.