Gestational diabetes mellitus (GDM) is a form of glucose intolerance that is first recognized during pregnancy and typically resolves postpartum. The global prevalence of GDM has been increasing steadily, with estimates suggesting that it affects approximately 7–14% of pregnancies depending on the diagnostic criteria used and population studied (1,2). In India, the prevalence ranges from 10% to 35%, influenced by urbanization, genetic predisposition, and changing dietary habits (3). GDM is associated with several short- and long-term maternal and neonatal complications, including preeclampsia, polyhydramnios, cesarean delivery, macrosomia, shoulder dystocia, and neonatal hypoglycemia (4,5).

Timely diagnosis and effective management of GDM are crucial for minimizing adverse outcomes. The International Association of Diabetes and Pregnancy Study Groups (IADPSG) has recommended a one-step 75-gram oral glucose tolerance test (OGTT) as the standard diagnostic approach, which has been widely adopted, including in resource-limited settings (6). Glycemic control through medical nutrition therapy and insulin therapy, when required, has shown to significantly improve pregnancy outcomes in women with GDM (7). However, challenges in achieving optimal glycemic control are particularly pronounced in low-resource healthcare settings where access to monitoring and treatment options may be limited (8).

Furthermore, maternal comorbidities such as gestational hypertension, chronic hypertension, and hypothyroidism can further complicate the management of GDM and contribute to poor neonatal outcomes including increased rates of neonatal intensive care unit (NICU) admissions, respiratory distress, and perinatal mortality (9,10). Despite these challenges, early intervention and tailored management strategies have demonstrated the potential to mitigate risks and improve maternal-neonatal health outcomes.

This study was conducted to evaluate the clinical and neonatal outcomes associated with GDM in a resource-constrained tertiary care center. Additionally, it aims to assess the impact of glycemic control and associated comorbidities on the course and outcome of pregnancy.

This prospective observational study was Conducted in Pandit Deen Dayal Upadhayay Goverment Hospital, Varanasi over six months, from August 2024 to January 2025.

A total of 162 pregnant women diagnosed with gestational diabetes mellitus (GDM) were enrolled in the study based on the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. The diagnosis was made using a 75-gram oral glucose tolerance test (OGTT), where venous blood glucose levels were measured fasting, and at 1 hour and 2 hours post-glucose load. The diagnostic thresholds were ≥92 mg/dL (fasting), ≥180 mg/dL (1-hour), and ≥153 mg/dL (2-hour), with GDM confirmed if any one of these values was exceeded.

Women with pre-existing type 1 or type 2 diabetes mellitus, multiple pregnancies, known fetal anomalies, or systemic illnesses unrelated to pregnancy were excluded from the study. Age- and parity-matched pregnant women with normal glucose tolerance served as controls for comparison.

Data collection included detailed obstetric history, anthropometric measurements, and laboratory investigations. Body mass index (BMI) was calculated using pre-pregnancy weight and height. Laboratory evaluations comprised fasting and postprandial blood glucose, glycosylated hemoglobin (HbA1c), lipid profile, and thyroid function tests. Blood pressure readings were monitored routinely to identify gestational or chronic hypertension.

Participants were managed according to standard GDM protocols, which included medical nutrition therapy (MNT) and exercise recommendations. Insulin therapy was initiated in cases where glycemic control could not be maintained through lifestyle modification alone. Glycemic control was monitored regularly through capillary blood glucose testing.

All participants were followed throughout their antenatal period until delivery. Mode of delivery, obstetric complications, and maternal outcomes such as preeclampsia, polyhydramnios, and preterm labor were recorded. Neonatal outcomes included birth weight, Apgar scores, NICU admissions, macrosomia, hypoglycemia, and perinatal mortality.

Data were analyzed using SPSS version 21. Descriptive statistics were expressed as means, standard deviations, and percentages. Comparative analyses between groups were performed using the Chi-square test for categorical variables and Student’s t-test for continuous variables. A p-value of less than 0.05 was considered statistically significant.

A total of 162 pregnant women diagnosed with gestational diabetes mellitus (GDM) were included in the study. The mean maternal age was 29.4 ± 4.2 years, and the average body mass index (BMI) was 29.6 ± 3.8 kg/m². Most participants were multigravida (61.7%), and 38.3% were primigravida. Maternal comorbidities were commonly observed, including gestational hypertension (21%), chronic hypertension (5.5%), and hypothyroidism (28%) (Table 1).

Out of 162 women, 116 (72%) required insulin therapy in addition to dietary modifications. Optimal glycemic control was achieved in 107 (66%) of cases. Cesarean delivery was performed in 79 (48.8%) women, while the remaining 83 (51.2%) had vaginal deliveries. Antenatal or intrapartum complications such as preeclampsia, polyhydramnios, and preterm labor were recorded in 50 (30.9%) participants.

Neonatal outcomes showed that 5 (3.1%) infants were macrosomic (birth weight > 4 kg), 29 (17.9%) required NICU admission, and 2 (1.2%) experienced early neonatal death. Neonates born to mothers who achieved optimal glycemic control had significantly lower NICU admissions (10%) compared to those with poor glycemic control (29%) (p < 0.05). Additionally, hypoglycemia occurred in 7 (4.3%) newborns, all of whom were from the poorly controlled group (Table 2).

These findings indicate that tight glycemic control through insulin therapy significantly reduced the incidence of adverse neonatal outcomes and maternal complications (Table 2).

Table 1: Maternal Demographic and Clinical Characteristics (n=162)

Table 2: Neonatal Outcomes and Comparison Based on Maternal Glycemic Control

These tables demonstrate the notable difference in neonatal outcomes based on maternal glycemic control (Table 2), highlighting the importance of early intervention and stringent monitoring during pregnancy in patients with GDM.

Gestational diabetes mellitus (GDM) has emerged as a significant public health concern due to its growing prevalence and the associated risks for both mothers and neonates. The present study demonstrates that women diagnosed with GDM, particularly in low-resource settings, are at increased risk of adverse maternal and neonatal outcomes, including cesarean delivery, hypertensive disorders, and neonatal intensive care unit (NICU) admissions. However, effective glycemic control, particularly through insulin therapy, was associated with improved outcomes.

Our findings align with previous studies indicating that GDM is often accompanied by comorbid conditions such as gestational hypertension and hypothyroidism, which further exacerbate maternal and fetal risks (1,2). The observed rate of gestational hypertension (21%) and hypothyroidism (28%) in our cohort is comparable to data reported in Indian and global studies (3,4). These comorbidities may result from shared metabolic disturbances, including insulin resistance and endothelial dysfunction, contributing to pregnancy complications (5).

Insulin therapy was required in 72% of participants, consistent with studies showing that dietary and lifestyle measures alone are insufficient for glycemic control in a significant proportion of women with GDM (6,7). Achieving optimal glycemic control, observed in 66% of our patients, was significantly associated with reduced neonatal complications such as NICU admissions and neonatal hypoglycemia. These outcomes are supported by evidence indicating that meticulous glucose regulation lowers the risk of adverse perinatal events (8,9).

The rate of cesarean deliveries in the GDM group (48.8%) was relatively high, which reflects a global trend associated with GDM management (10). Contributing factors include macrosomia, non-reassuring fetal status, and obstetrician preference in high-risk pregnancies (11). However, the incidence of macrosomia in this study was relatively low (3.1%), possibly due to effective glycemic monitoring and timely initiation of insulin in poorly controlled cases. This finding aligns with recent data suggesting that good metabolic control can substantially reduce macrosomia rates (12).

Neonatal outcomes such as NICU admissions (17.9%) and neonatal hypoglycemia (4.3%) were predominantly seen in infants of mothers with poor glycemic control, underscoring the importance of antenatal glucose management. The increased risk of metabolic derangements, respiratory distress, and hypoglycemia in such neonates is well established in the literature (13,14). In contrast, those born to mothers with controlled GDM had significantly better outcomes, including higher Apgar scores and fewer NICU admissions, which supports the hypothesis that early glycemic intervention can influence neonatal prognosis favorably (15).

One of the strengths of this study is its real-world application in a resource-limited clinical setting, where implementation of simple measures such as dietary counseling, regular glucose monitoring, and insulin therapy when required, had a tangible impact on reducing complications. However, limitations include the single-center design, lack of long-term neonatal follow-up, and potential bias due to variations in patient compliance and health literacy.

In conclusion, this study reaffirms the importance of early detection and optimal management of GDM. Regular antenatal care, multidisciplinary support, and aggressive glycemic control strategies can mitigate the burden of GDM even in economically constrained environments. Integration of these practices into routine obstetric care is essential to improve maternal and neonatal health outcomes.

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