Gestational diabetes mellitus (GDM) is a condition of glucose intolerance that is diagnosed for the first time in pregnancy and is one of the most frequent metabolic disorders in pregnancy worldwide. Rising maternal age, obesity, sedentary lifestyles, and the growing incidence of type 2 diabetes mellitus (T2Dm) have contributed to a significant rise in the prevalence of GDM in the last 20 years. There is a worldwide estimate of up to 7-20% of pregnancies being affected by GDM, and a higher incidence of GDM in South Asian populations is due to genetic susceptibility and lifestyle-related risk factors [11,12]. During pregnancy, there is a natural resistance to insulin, especially in the second and third trimesters. Placental hormones, such as human placental lactogen, progesterone, cortisol, and growth hormone, are all involved with insulin resistance to ensure proper glucose to the baby. If our pancreatic β-cell function does not meet this increased demand for insulin, our mother's blood sugar levels rise, which leads to gestational diabetes mellitus [13,14]. There are many complications associated with GDM. Women who develop GDM are more likely to get hypertensive disorders of pregnancy (preeclampsia, gestational hypertension, and eclampsia). In addition, these women have a higher risk for polyhydramnios, prolonged labor, operative vaginal delivery, and cesarean section. Maternal hyperglycemia also puts affected women at risk for complications in the postpartum period and at long-term risk for type 2 diabetes mellitus and cardiovascular diseases [15]. GDM has consequences that go beyond maternal health and include the outcomes for the newborn. Glucose crosses the placenta, and the fetal cells have more glucose than they can handle, causing fetal hyperinsulinemia and accelerated fetal growth. Infants of "diabetic" mothers are therefore at a higher risk for macrosomia, shoulder dystocia, birth trauma, hypoglycemia, respiratory distress syndrome, hyperbilirubinemia, and admission to a neonatal intensive care unit (NICU). Untreated GDM can lead to complications in the pregnancy and birth, especially in severe cases [16]. Several studies have shown that the impact of early diagnosis and appropriate glycemic management can significantly improve adverse maternal and fetal outcomes. The treatment of GDM is a cornerstone of lifestyle modifications, dietary counseling, frequent testing of glycemic levels, and medication, including insulin or metformin. Tragically, adverse pregnancy outcomes are still widespread, even with the development of screening and treatment strategies, especially in LMICs where specialized antenatal care might not be available [17,18]. Diabetes and obesity have become a burgeoning problem in Pakistan, and GDM is becoming a serious public health issue. But information on maternal and neonatal outcomes linked to GDM is still scarce in the local context. It is important to understand the range of problems that can arise in affected pregnancies so as to optimise antenatal care policies and design specific interventions [19].Hence, this study was done to assess the maternal and neonatal outcomes of women with gestational diabetes mellitus and to find out the prevalence of related complications in the tertiary care hospital environment [20].

Study Objective

To evaluate outcomes of mother and infant, and the incidence of pregnancy-related complications in women with GDM

Study Design and Setting A cross-sectional study was carried out in Department of Obstetrics and Gynecology Saidu Group of Teaching Hospitals, Swat, Pakistan from January 2025 to December 2025. Participants The subjects were 100 pregnant women with GDM who were consecutively sampled. Eligible subjects were recruited at routine antenatal check-ups and followed up until delivery. A standardized data collection form was used to document demographic information, obstetric history, maternal complications, treatment details, and neonatal outcomes. Sample Size Calculation The number of samples n was calculated based on the WHO sample size formula: n = Z²P(1−P)/d², where Z is the value for the degree of confidence (0.95), P is the proportion of the population (0.5), and d is the level of accuracy (0.05). With a 50% prevalence of adverse maternal outcomes, a 95% level of confidence, and a 10% margin of error, the sample size of 96 was adequate. 100 women were included to boost statistical power and to have a complete record. Inclusion Criteria • Women of reproductive age (18-45 years old) who are pregnant. • Singleton pregnancy. • Standard oral glucose tolerance test (OGTT) criteria were used to diagnose gestational diabetes mellitus (GDM). • Ability to take part in the study. Exclusion Criteria • Type 1 or type 2 diabetes mellitus (pre-existing). • Multiple gestation pregnancies. • Known fetal congenital anomalies. • Chronic renal disease, hepatic disease, or cardiovascular disease. • Incomplete clinical records. Diagnostic and Management Strategy The diagnosis of gestational diabetes mellitus was made with an oral glucose tolerance test (OGT) with 75 g. Dietary counseling and lifestyle modification advice were given to all patients. The women who had poor glycemic control received treatment with metformin and/or insulin therapy as per institutional management protocols. Statistical Analysis Data was analysed with SPSS version 27.0. Continuous variables were reported as mean ± standard deviation, and categorical variables were reported as number and percentage. Chi-square and independent t-tests were used to examine the associations between maternal characteristics and outcomes. A p-value < 0.05 was considered statistically significant.

A total of 100 women with gestational diabetes mellitus were included in the analysis. The mean maternal age was 31.4 ± 5.8 years, with the majority of participants (58%) being multiparous. The mean gestational age at diagnosis was 27.6 ± 3.2 weeks. A family history of diabetes was reported in 41% of women, while 36% had a body mass index ≥30 kg/m². Regarding maternal outcomes, cesarean section was performed in 62% of participants, making it the most common mode of delivery. Preeclampsia developed in 18% of women, preterm delivery occurred in 22%, and polyhydramnios was observed in 12%. Women aged above 35 years demonstrated a significantly higher prevalence of preeclampsia compared to younger participants (28% vs. 13%; p=0.041). Neonatal outcomes revealed a mean birth weight of 3.42 ± 0.61 kg. Macrosomia was present in 20% of neonates, while neonatal hypoglycemia occurred in 15%. Respiratory distress syndrome was reported in 10% of newborns, hyperbilirubinemia in 14%, and NICU admission in 18%. Adverse neonatal outcomes were significantly more frequent among mothers with poor glycemic control than those achieving adequate glycemic control (32% vs. 14%; p=0.021). Maternal obesity was significantly associated with cesarean delivery (p=0.034), indicating the combined effect of obesity and GDM on pregnancy outcomes.

Table 1. Baseline Characteristics of Women with Gestational Diabetes Mellitus (N = 100)

Values are presented as frequency (percentage) or mean ± standard deviation. BMI: Body Mass Index.

Table 2. Maternal Outcomes Among Women with Gestational Diabetes Mellitus (N = 100)

Maternal outcomes observed during pregnancy and delivery among women diagnosed with gestational diabetes mellitus.

Table 3. Neonatal Outcomes in Pregnancies Complicated by Gestational Diabetes Mellitus (N = 100)

Neonatal outcomes assessed immediately after birth and during the neonatal period. NICU: Neonatal Intensive Care Unit.

Table 4. Factors Associated with Adverse Maternal and Neonatal Outcomes

Chi-square test was used to evaluate associations between maternal factors and adverse outcomes. A p-value <0.05 was considered statistically significant. Significant associations are highlighted by p-values below 0.05.

In the present study, women with gestational diabetes mellitus (GDM) have been assessed for their maternal and neonatal outcomes after standard antenatal care, and a significant burden of adverse outcomes was observed. Our study had a mean maternal age of 31.4 ± 5.8 years, similar to the mean ages of recent studies conducted in women with GDM (29–33 years) [11,12]. There is a known association between advanced maternal age and the development of complications associated with GDM. The women in our cohort were also more likely to develop preeclampsia (p=0.041) compared with the results of recent multicenter studies [13]. The most common mode of delivery was cesarean delivery (62%). Studies from the period 2021-2025 have found similar cesarean section rates, ranging from 55% to 68% [14]. The higher operability rate of women with GDM could be explained by fetal macrosomia, maternal obesity, and obstetric conditions. In the same way, the maternal obesity was found to be significantly associated with cesarean delivery (p=0.034) in our study, which is consistent with the findings of Ahmed et al. and Kim et al., who concluded that high BMI was an independent risk factor for operative delivery in GDM pregnancies [15]. The most common maternal complications included preeclampsia (18%) and preterm delivery (22%). The rates of preterm birth and preeclampsia, reported here, are comparable to those recently reported by systematic reviews, which reported rates of preterm birth of 18-25% and preeclampsia of 12-20% among women with GDM [16]. It is hypothesized that these adverse outcomes are due to hyperglycemia-induced endothelial dysfunction, oxidative stress, and abnormal placentation. The incidence of polyhydramnios (12%) in this study was also similar to that found in the recent literature [17]. Infant problems continued to be a major issue. The mean birth weight was 3.42 ± 0.61 kg, and macrosomia was observed in 20% of the neonates. Recent studies conducted in Asia and the Middle East showed similar rates of macrosomia (16–24%) [18]. High blood glucose levels leading to hyperglycemia in the mother lead to increased glucose transport across the placenta, which increases insulin production in the fetus and leads to increased fetal growth. Thus, babies of GDM women are still at a higher risk of birth trauma and metabolic problems [19]. Fifteen percent of newborns had neonatal hypoglycemia, and 10% had respiratory distress syndrome. These results agree with Singh et al. and Martinez et al., who reported a value of neonatal hypoglycemia (12% to 18%) and respiratory distress (8% to 14%). Fetal hyperinsulinemia after birth is thought to be the most important cause of neonatal hypoglycemia. Similarly, maternal hyperglycemia can cause delayed pulmonary maturation, which can lead to respiratory morbidity [20].

Limitations

The present study has a few limitations. Due to the number of centers and relatively small sample size, findings may be limited in generalizability. The cross-sectional design doesn't allow causal inferences or long-term maternal or neonatal outcomes. Further, other factors that could have confounded results were not assessed with multivariable analysis.

GDM is linked with higher rates of maternal morbidity (cesarean delivery, preeclampsia, prematurity, macrosomia, and NICU admission) and neonatal morbidity. Sugar control is a critical factor that can have a major impact on outcomes. Good glucose control and timely diagnosis, if usefully conducted, is crucial to good pregnancy outcomes and a reduction in pregnancy complications.

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