The burden of gestational diabetes mellitus (GDM) has been rising across India, reflecting transitions in maternal age, adiposity, nutrition, and urbanization, with substantial implications for maternal and child health.1 In a population-based cohort from South Delhi, the incidence of GDM was 19.2% when women were screened longitudinally, underscoring the magnitude of the problem even in urban settings with access to care.2 At the national program level, India has adopted universal screening using a single-step 75 g oral glucose tolerance test (OGTT), aiming to integrate GDM services throughout the antenatal care continuum. These guidelines reflect pragmatic considerations in busy public systems and emphasize identification, counselling, diet therapy, pharmacotherapy when indicated, and postpartum re-testing, while accommodating both fasting and non-fasting workflows.3 A systematic review of South Asian studies found positive associations with macrosomia and maternal preeclampsia, while relationships with low birth weight, stillbirth, and caesarean delivery were less consistent, partly due to small samples and varied standards of care.4 In a large records-based study from Chennai (WINGS-3), women with GDM had higher emergency caesarean and preeclampsia rates and more macrosomia compared to those without GDM, especially when managed with medical nutrition therapy alone.5 From the neonatal perspective, hypoglycaemia, higher birth weight/large-for-gestational-age (LGA), hyperbilirubinemia, and respiratory morbidities are commonly reported in infants of GDM mothers. A hospital-based paediatric study from Tamil Nadu documented significantly higher hypoglycaemia, LGA, transient tachypnoea, respiratory distress, and polycythaemia among neonates of GDM mothers compared with non-GDM counterparts. 6 In Gujarat, emerging reports from rural and semi-urban tertiary facilities indicate a “silent upsurge” in GDM highlighting both rising prevalence and gaps in awareness and postpartum follow-up. Yet, there remains a need for region specific hospital-based data on risk profiles and outcomes to complement programmatic figures. Therefore, this study aimed to evaluate risk factors and maternal-fetal outcomes in pregnant women diagnosed with GDM at a tertiary care facility in Gujarat, India.

Study Design and Setting: This prospective observational study was conducted at a tertiary care hospital in Gujarat, India, over a period of 18 months from January 2023 to June 2024. The study was approved by the Institutional Ethics Committee and conducted in accordance with the Declaration of Helsinki principles. Study Population: The study included 200 pregnant women attending the antenatal outpatient department between 24-28 weeks of gestation. Sample size calculation was based on an GDM prevalence of 15% in previous study7 with 5% precision and 95% confidence level, yielding a minimum requirement of 196 participants. Inclusion Criteria: Pregnant women aged between 18 and 40 years with a singleton pregnancy and a gestational age of 24–28 weeks, confirmed either by last menstrual period or early ultrasound, were eligible for inclusion. Only those who were willing to participate and provided informed consent were enrolled in the study Exclusion Criteria: Women were excluded if they had pre-gestational diabetes mellitus (Type 1 or Type 2), multiple pregnancies, major fetal congenital anomalies, or chronic medical conditions such as chronic hypertension, renal disease, or liver disease. Those on current corticosteroid therapy or with a previous history of bariatric surgery were also excluded. Data Collection: A standardized proforma was used to collect demographic data, obstetric history, family history of diabetes, anthropometric measurements, and clinical parameters. Body Mass Index (BMI) was calculated using pre-pregnancy weight and height measurements. GDM Screening and Diagnosis: All participants underwent 75g oral glucose tolerance test (OGTT) following the DIPSI guidelines. After overnight fasting of 8-12 hours, fasting plasma glucose was measured. Subsequently, 75g of anhydrous glucose dissolved in 300ml water was administered orally, and 2-hour post-glucose plasma glucose levels were determined. GDM was diagnosed if 2-hour plasma glucose ≥140 mg/dL. Gestational glucose intolerance (GGI) was defined as 2-hour plasma glucose between 120-139 mg/dL. Management Protocol: Women diagnosed with GDM received comprehensive management including medical nutrition therapy, blood glucose monitoring, and insulin therapy when indicated. Fasting plasma glucose >95 mg/dL or 2-hour postprandial glucose >120 mg/dL after two weeks of dietary management warranted insulin initiation. Outcome Measures: Primary outcomes included maternal complications (pregnancy-induced hypertension, preeclampsia, polyhydramnios, mode of delivery) and neonatal outcomes (birth weight, macrosomia defined as >3.5 kg, NICU admissions, neonatal hypoglycaemia, respiratory complications). Secondary outcomes included postpartum glucose tolerance status at 6-week follow-up. Follow-up: All participants were followed until delivery, with detailed documentation of labour and delivery events. Neonatal outcomes were recorded within 24-48 hours of birth. Postpartum follow-up was conducted at 6 weeks to assess glucose tolerance status using fasting and 2-hour postprandial glucose measurements. Statistical Analysis: Data analysis was performed using SPSS version 26.0. Categorical variables were presented as frequencies and percentages, while continuous variables were expressed as mean ± standard deviation. Chi-square test was used for categorical variables and t-test for continuous variables. Multivariable logistic regression estimated adjusted odds ratios (aORs) with 95% CIs for associations between maternal risk factors and GDM. Statistical significance was set at p<0.05.

A total of 200 pregnant women were included in the study, of whom 37 (18.5%) were diagnosed with gestational diabetes mellitus (GDM), 22 (11.0%) with gestational glucose intolerance (GGI), and 141 (70.5%) had normal glucose tolerance (NGT). Table 1: Baseline characteristics and risk factors in GDM, GGI, and NGT groups (n=200) Factors GDM (n=37) GGI (n=22) NGT (n=141) p-value Maternal age (years), mean ± SD 28.9 ± 4.1 27.4 ± 3.6 25.8 ± 3.8 0.012 Age >25 years 26 (70.3%) 12 (54.5%) 58 (41.1%) 0.018 BMI ≥25 kg/m² 14 (37.8%) 6 (27.3%) 20 (14.2%) 0.006 Family history of diabetes 11 (29.7%) 4 (18.2%) 15 (10.6%) 0.021 Multigravida 23 (62.2%) 13 (59.1%) 77 (54.6%) 0.541 Previous obstetric complications 10 (27.0%) 4 (18.2%) 12 (8.5%) 0.037 The mean age of women with GDM was significantly higher compared to those with GGI and NGT (28.9 ± 4.1 vs. 27.4 ± 3.6 and 25.8 ± 3.8 years; p = 0.012). A higher proportion of women with GDM were aged >25 years (70.3%) compared to GGI (54.5%) and NGT (41.1%). Similarly, overweight/obesity (BMI ≥25 kg/m²) was more frequent among women with GDM (37.8%) and GGI (27.3%) compared to NGT (14.2%; p = 0.006). Family history of diabetes and previous adverse obstetric outcomes were also significantly associated with GDM (p < 0.05) [Table 1]. Table 2: Maternal antenatal complications and delivery outcomes in GDM, GGI, and NGT groups Complications GDM (n=37) GGI (n=22) NGT (n=141) p-value PIH / Preeclampsia 8 (21.6%) 3 (13.6%) 10 (7.1%) 0.041 Polyhydramnios 5 (13.5%) 2 (9.1%) 6 (4.3%) 0.089 Preterm labor 4 (10.8%) 2 (9.1%) 9 (6.4%) 0.612 Mode of delivery: LSCS 18 (48.6%) 9 (40.9%) 41 (29.1%) 0.043 – Elective LSCS 12 (32.4%) 5 (22.7%) 20 (14.2%) – Emergency LSCS 6 (16.2%) 4 (18.2%) 21 (14.9%) Vaginal delivery 17 (45.9%) 12 (54.5%) 95 (67.4%) Instrumental delivery 2 (5.4%) 1 (4.5%) 5 (3.5%) Hypertensive disorders of pregnancy were significantly more common in the GDM group (21.6%) compared to NGT (7.1%; p = 0.041). Polyhydramnios was more frequent in GDM (13.5%) and GGI (9.1%) than in NGT (4.3%), although the difference was not statistically significant. The rate of caesarean section (LSCS) was highest among women with GDM (48.6%), followed by GGI (40.9%) and NGT (29.1%; p = 0.043). Nearly one-third of GDM women underwent elective LSCS. Vaginal deliveries were more common in the NGT group (67.4%) [Table 2]. Table 3: Fetal and neonatal outcomes in GDM, GGI, and NGT groups. Outcome GDM (n=37) GGI (n=22) NGT (n=141) p-value Preterm birth 6 (16.2%) 3 (13.6%) 11 (7.8%) 0.188 Mean birth weight (kg) 3.12 ± 0.54 2.98 ± 0.48 2.84 ± 0.52 0.027 Macrosomia (>3.5 kg) 7 (18.9%) 3 (13.6%) 9 (6.4%) 0.041 Low birth weight (<2.5 kg) 5 (13.5%) 3 (13.6%) 20 (14.2%) 0.982 NICU admission 8 (21.6%) 4 (18.2%) 12 (8.5%) 0.043 Congenital anomalies 1 (2.7%) 0 (0.0%) 2 (1.4%) 0.744 Stillbirth / Neonatal death 1 (2.7%) 1 (4.5%) 2 (1.4%) 0.532 Women with GDM delivered infants with a higher mean birth weight (3.12 ± 0.54 kg) compared to GGI (2.98 ± 0.48 kg) and NGT (2.84 ± 0.52 kg; p = 0.027). The frequency of macrosomia (>3.5 kg) was significantly higher among GDM (18.9%) compared to GGI (13.6%) and NGT (6.4%; p = 0.041). NICU admissions were also more frequent in GDM (21.6%) compared to GGI (18.2%) and NGT (8.5%; p = 0.043). The incidence of congenital anomalies and perinatal deaths was low across all groups, without statistically significant differences [Table 3]. Table 4: Association of maternal risk factors with occurrence of GDM Risk factor GDM (n=37) GGI (n=22) NGT (n=141) Adjusted OR (95% CI) p-value Age >25 years (n=96) 26 (27.1%) 12 (12.5%) 58 (60.4%) 2.2 (1.1–4.5) 0.019 BMI ≥25 kg/m² (n=40) 14 (35.0%) 6 (15.0%) 20 (50.0%) 2.7 (1.2–6.3) 0.013 Family history of DM (n=30) 11 (36.7%) 4 (13.3%) 15 (50.0%) 3.1 (1.2–7.9) 0.018 Previous obstetric complications (n=26) 10 (38.5%) 4 (15.4%) 12 (46.2%) 3.4 (1.3–8.6) 0.014 Multigravida (n=113) 23 (20.4%) 13 (11.5%) 77 (68.1%) 1.2 (0.6–2.5) 0.472 Multivariable analysis demonstrated that maternal age >25 years (OR 2.2; 95% CI: 1.1–4.5), BMI ≥25 kg/m² (OR 2.7; 95% CI: 1.2–6.3), family history of diabetes (OR 3.1; 95% CI: 1.2–7.9), and previous obstetric complications (OR 3.4; 95% CI: 1.3–8.6) were significantly associated with increased odds of developing GDM. Gravidity was not significantly associated with GDM risk [Table 4]. Table 5: Maternal postpartum glycemic status at 6 weeks follow-up Glycaemic status GDM (n=30) GGI (n=18) NGT (n=120) Total (n=168) Normal glucose tolerance 18 (60.0%) 14 (77.8%) 120 (100.0%) 152 (90.5%) Impaired fasting glucose 7 (23.3%) 3 (16.7%) 0 (0.0%) 10 (6.0%) Diabetes mellitus 5 (16.7%) 1 (5.6%) 0 (0.0%) 6 (3.6%) Follow-up at 6 weeks was available in 168 women (30 GDM, 18 GGI, 120 NGT). Among women with prior GDM, 16.7% developed overt diabetes and 23.3% had impaired fasting glucose, whereas only 5.6% of GGI and none of NGT women developed diabetes. Thus, nearly 40% of women with GDM had abnormal glucose tolerance at 6 weeks postpartum, underscoring the importance of continued follow-up [Table 5].

Prevalence of GDM: The current study demonstrates a GDM prevalence of 18.5% in our tertiary care hospital setting in Gujarat, India, which aligns with urban Indian study from South Delhi (19.2%).2 Recent NFHS data report a weighted GDM prevalence of 4.2% with age-adjusted prevalence of 5.4% There was significant regional variations in GDM prevalence, with states like Kerala, Meghalaya, and Goa showing higher prevalence rates, suggesting significant regional variations and potentially highlighting the higher burden in tertiary care settings where high-risk pregnancies are more commonly managed.8 Risk-factor profile and implications: In the present study, independent associations of GDM with age >25 years, BMI ≥25 kg/m², family history of diabetes, and prior adverse obstetric outcomes are biologically and epidemiologically plausible. In a population-based study from North India, age, BMI, baseline HbA1c, and preconception prediabetes were strong predictors of GDM, with taller height conferring slight protection, emphasizing the interplay of metabolic milieu and anthropometry in risk.2 Outcome: In the present study, GDM was associated with increased preeclampsia, caesarean delivery, macrosomia, and NICU admissions, consistent with prior Indian hospital reports. Data from WINGS-3 (Chennai) also showed higher emergency caesarean, preeclampsia, and macrosomia rates in GDM. The caesarean proportion in our cohort (48.6%) aligns with the upper range of Indian findings (e.g., Mumbai: 52%), reflecting operative delivery risk linked to fetal size, induction failure, and hypertensive disorders5,9 In the present study, preeclampsia among GDM women (21.6%) was comparable to Indian cohorts (e.g., Mumbai: 26%) and consistent with a South Asian review linking GDM with higher preeclampsia risk, underscoring the need for closer blood pressure monitoring alongside glycaemic control.4,9 In the present study, macrosomia (>3.5 kg) was more frequent in GDM (18.9%), aligning with WINGS-3 (13.9% vs 10.8%) and lower than a Mumbai cohort (40%).5,9 In the present study, NICU admissions were also higher in GDM (21.6%), consistent with reports of increased neonatal hypoglycaemia, respiratory distress, TTN, and hyperbilirubinemia. A Tamil Nadu paediatric study similarly noted elevated hypoglycaemia and LGA among GDM-exposed neonates, reinforcing the need for anticipatory newborn monitoring.6 Programmatic context and diagnostic frameworks: India’s guidelines recommend universal single-step 75 g OGTT screening (2 h ≥140 mg/dL) to optimize case detection. DIPSI-based studies report GDM prevalence of 7.9–>13% in Rajasthan, reflecting regional and test variability. With our observed prevalence of ~18.5%, systematic universal screening at first contact, with repeat testing at 24–28 weeks if initially normal, is warranted in tertiary centers.3,10 Postpartum follow-up: In the present study, 16.7% of women with prior GDM had overt diabetes and 23.3% had impaired fasting glucose at 6 weeks postpartum, aligning with a Mumbai study (~16%). These findings reinforce the need for strengthened postpartum re-testing, primary care transition, and lifestyle counselling to reduce long-term diabetes risk.9 LIMITATIONS This single-center study may limit generalizability beyond similar tertiary-care settings in Gujarat. GDM definitions and thresholds followed institutional protocols, potentially affecting external comparability (e.g., DIPSI vs IADPSG). Residual confounding, incomplete 6-week postpartum follow-up, and lack of long-term glycaemic outcomes may influence findings. Neonatal metabolic morbidity was inferred from NICU admissions rather than universal biochemical screening

This study demonstrates a high prevalence of GDM (18.5%) in our tertiary care setting in Gujarat, with significant associations between advanced maternal age, elevated BMI, family history of diabetes, and GDM development. The increased rates of maternal complications (preeclampsia, caesarean delivery) and adverse neonatal outcomes (macrosomia, NICU admissions) underscore the clinical significance of GDM. The finding that 40% of women with prior GDM exhibited abnormal glucose tolerance at early postpartum follow-up highlights the critical importance of systematic postpartum screening and long-term metabolic surveillance.

1. Yadav M, Sharma G, Bhargava S, Sharma S, Maheshwari M. Impact of gestational diabetes mellitus on maternal & fetal outcome. Indian J Obstet Gynecol Res 2016;3(4)330-3. 2. Bahl S, Dhabhai N, Taneja S, Mittal P, Dewan R, Kaur J, et al. Burden, risk factors and outcomes associated with gestational diabetes in a population-based cohort of pregnant women from North India. BMC Pregnancy Childbirth [Internet]. 2022;22(1):1–6. Available from: https://doi.org/10.1186/s12884-022-04389-5 3. National Health Mission. National Guidelines for Diagnosis & Management of Gestational Diabetes Mellitus [Internet]. New Delhi: Ministry of Health & Family Welfare; [cited on 21st June 2025 ]. Available from https//nhm.gov.in/images/pdf/programmes/maternal-health/guidelines/National_Guidelines_for_Diagnosis_&_Management_of_Gestational_Diabetes_Mellitus.pdf. 4. Mistry SK, Das Gupta R, Alam S, Kaur K, Shamim AA, Puthussery S. Gestational diabetes mellitus (GDM) and adverse pregnancy outcome in South Asia: A systematic review. Endocrinol Diabetes Metab. 2021;4(4):1–9. 5. Mahalakshmi M, Bhavadharini B, Maheswari K, Kalaiyarasi G, Anjana R, Ranjit U, et al. Comparison of maternal and fetal outcomes among Asian Indian pregnant women with or without gestational diabetes mellitus: A situational analysis study (WINGS-3). Indian J Endocrinol Metab. 2016;20(4):491–6. 6. K. MS, Kishore SA, P. N, C. S. Neonatal outcome in pregnancies complicated by gestational diabetes mellitus: a hospital based study. Int J Contemp Pediatr. 2018;5(3):737–42. 7. Prachishree L, Padhy SK, Mickey AR, Jena R, chandra Pradhan P. Prevalence and Risk Factors of Gestational Diabetes Mellitus in Pregnant Women in Cuttack, Odisha, India: A Cross-Sectional Study. Eur J Cardiovasc Med 2025 Jan 4;1515-9. 8. Chakraborty A, Yadav S. Prevalence and determinants of gestational diabetes mellitus among pregnant women in India: an analysis of National Family Health Survey Data. BMC Women’s Heal 2024 Feb 29;24(1)147. 9. Dudhwadkar AR, Fonseca MN. Maternal and fetal outcome in gestational diabetes mellitus. Int J Reprod Contracept Obs Gynecol 2016;53317-21. 10. Makwana M, Bhimwal RK, Ram C, Mathur SL, Lal K, Mourya H. Gestational diabetes mellitus with its maternal and foetal outcome: a clinical study. Int J Adv Med. 2017;4(4):919.