IMPACT OF GESTATIONAL DIABETES ON NEONATAL OUTCOMES: A MULTICENTER CROSS-SECTIONAL STUDY IN PAKISTAN
Main Article Content
Keywords
Gestational diabetes mellitus; Neonatal outcomes; Hypoglycemia; Macrosomia; NICU admission; Pakistan
Abstract
Abstract
Objective: To evaluate the association between Gestational Diabetes Mellitus (GDM) and neonatal outcomes across major public-sector tertiary care hospitals in Pakistan.
Methods: This analytical cross-sectional multicenter study was conducted from August 2024 to February 2025 across five public-sector tertiary hospitals in Pakistan. A total of 500 mother–infant pairs were included. Among them, 250 mothers were diagnosed with GDM using a 75 g Oral Glucose Tolerance Test (OGTT), while 250 were non-GDM. Neonatal outcomes assessed included birth weight, hypoglycemia, respiratory distress syndrome (RDS), macrosomia, and NICU admission. Neonatal blood glucose was measured at 2, 6, and 12 hours post-delivery. Hypoglycemia was defined as <40 mg/dL.
Results: Neonates exposed to GDM had significantly higher mean birth weight (3.65 ± 0.48 kg vs. 3.10 ± 0.32 kg; p < 0.001). Hypoglycemia was more frequent (26.4% vs. 3.2%; OR 9.15, 95% CI: 4.2–19.8). NICU admissions were higher (24.0% vs. 6.8%; OR 3.52). Respiratory distress was also increased (11.2% vs. 4.0%; p = 0.008). Macrosomia was more prevalents in the GDM group.
Conclusion: GDM is strongly associated with adverse neonatal outcomes in Pakistan. Early screening and timely management are essential to reduce neonatal morbidity.
References
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14. Yogev Y, Visser GH. Obesity, gestational diabetes and pregnancy outcome. Semin Fetal Neonatal Med. 2009;14(2):77–84. doi: 10.1016/j.siny.2008.09.002 (doi.org in Bing)
15. Jiwani A, Marseille E, Lohse N, Damm P, Hod M, Kahn JG. Gestational diabetes mellitus: results from a survey of country prevalence and practices. J Matern Fetal Neonatal Med. 2012;25(6):600–610. doi: 10.3109/14767058.2011.587921 (doi.org in Bing)
16. Hasan S, Ahmed S, Khan M, et al. Prevalence and outcomes of gestational diabetes in Pakistan: a hospital-based study. Pak J Med Sci. 2023;39(2):345–351. doi: 10.12669/pjms.39.2.345 (doi.org in Bing)
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22. Zhu Y, Zhang C. Prevalence of gestational diabetes and risk of adverse neonatal outcomes: systematic review and meta-analysis. BMJ. 2016;352:i396. doi: 10.1136/bmj.i396
23. Sheng B, et al. Short-term neonatal outcomes in women with gestational diabetes treated using metformin versus insulin: a systematic review and meta-analysis. Acta Diabetol. 2023;60(5):595–608. doi: 10.1007/s00592-022-02016-5 (doi.org in Bing)
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25. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676–682. doi: 10.2337/dc09-1848
26. Sacks DA, Hadden DR, Maresh M, et al. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG criteria: the HAPO Study. Diabetes Care. 2012;35(3):526–528. doi: 10.2337/dc11-1641
27. Wahabi HA, Fayed AA, Esmaeil SA, Alzeidan RA. Maternal and neonatal outcomes of gestational diabetes mellitus in a tertiary hospital in Saudi Arabia: a retrospective cohort study. J Clin Diagn Res. 2017;11(4):QC01–QC05. doi: 10.7860/JCDR/2017/24316.9646 (doi.org in Bing)
28. Rehman M, Asif Z, Ejaz A, Rehman M, et al. Cross-sectional study on the prevalence of gestational diabetes and its management practices in Pakistan. Insights J Life Soc Sci. 2024;6(2):112–118. Available from: ResearchGate (researchgate.net in Bing)
29. Shujat S, Bibi H, Jahan G. Mode of delivery and fetomaternal outcomes in gestational diabetes mellitus. Indus J Biosci Res. 2025;3(6):1787. doi: 10.70749/ijbr.v3i6.1787
30. Siddique A, Rasool MU, Naeem R, Mirza A, Naeem S, Hamid S. Cardiac defects in neonates born to mothers with gestational diabetes mellitus and their association with maternal treatment regime. JSMDC. 2025;7(1):45–52. Available from: https://jsmdc.pk
31. Kampmann U, Madsen LR, Skajaa GO, Iversen DS, Moeller N, Ovesen P. Gestational diabetes: a clinical update. World J Diabetes. 2015;6(8):1065–1072. doi: 10.4239/wjd.v6.i8.1065 (doi.org in Bing)
32. Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH. Global estimates of the prevalence of hyperglycemia in pregnancy. Diabetes Res Clin Pract. 2014;103(2):176–185. doi: 10.1016/j.diabres.2013.11.003 (doi.org in Bing)
33. Farrar D, Simmonds M, Griffin SJ, et al. Risk of neonatal and maternal outcomes in gestational diabetes: systematic review and meta-analysis. BMJ. 2016;354:i3625. doi: 10.1136/bmj.i3625
34. Yogev Y, Visser GH. Obesity, gestational diabetes and pregnancy outcome. Semin Fetal Neonatal Med. 2009;14(2):77–84. doi: 10.1016/j.siny.2008.09.002 (doi.org in Bing)
35. Jiwani A, Marseille E, Lohse N, Damm P, Hod M, Kahn JG. Gestational diabetes mellitus: results from a survey of country prevalence and practices. J Matern Fetal Neonatal Med. 2012;25(6):600–610. doi: 10.3109/14767058.2011.587921 (doi.org in Bing)
36. Hasan S, Ahmed S, Khan M, et al. Prevalence and outcomes of gestational diabetes in Pakistan: a hospital-based study. Pak J Med Sci. 2023;39(2):345–351. doi: 10.12669/pjms.39.2.345 (doi.org in Bing)
37. Khan R, Ali K, Khan Z. Neonatal outcomes in pregnancies complicated by gestational diabetes mellitus in Pakistan. J Ayub Med Coll Abbottabad. 2022;34(1):78–83. Available from: http://jamc.ayubmed.edu.pk (jamc.ayubmed.edu.pk in Bing)
38. American Diabetes Association. Standards of medical care in diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S1–S180. doi: 10.2337/dc24-Sint
39. World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Geneva: WHO; 2013. Available from: https://apps.who.int/iris/handle/10665/85975 (apps.who.int in Bing)
40. Bener A, Saleh NM, Al-Hamaq AO. Prevalence of gestational diabetes and associated maternal and neonatal complications in a fast-developing community: global comparison. Int J Womens Health. 2011;3:367–373. doi: 10.2147/IJWH.S26094 (doi.org in Bing)
2. Zhu Y, Zhang C. Prevalence of gestational diabetes and risk of adverse neonatal outcomes: systematic review and meta-analysis. BMJ. 2016;352:i396. doi: 10.1136/bmj.i396
3. Sheng B, et al. Short-term neonatal outcomes in women with gestational diabetes treated using metformin versus insulin: a systematic review and meta-analysis. Acta Diabetol. 2023;60(5):595–608. doi: 10.1007/s00592-022-02016-5 (doi.org in Bing)
4. Billionnet C, Mitanchez D, Weill A, et al. Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia. 2017;60(4):636–644. doi: 10.1007/s00125-017-4206-6 (doi.org in Bing)
5. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676–682. doi: 10.2337/dc09-1848
6. Sacks DA, Hadden DR, Maresh M, et al. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG criteria: the HAPO Study. Diabetes Care. 2012;35(3):526–528. doi: 10.2337/dc11-1641
7. Wahabi HA, Fayed AA, Esmaeil SA, Alzeidan RA. Maternal and neonatal outcomes of gestational diabetes mellitus in a tertiary hospital in Saudi Arabia: a retrospective cohort study. J Clin Diagn Res. 2017;11(4):QC01–QC05. doi: 10.7860/JCDR/2017/24316.9646 (doi.org in Bing)
8. Rehman M, Asif Z, Ejaz A, Rehman M, et al. Cross-sectional study on the prevalence of gestational diabetes and its management practices in Pakistan. Insights J Life Soc Sci. 2024;6(2):112–118. Available from: ResearchGate (researchgate.net in Bing)
9. Shujat S, Bibi H, Jahan G. Mode of delivery and fetomaternal outcomes in gestational diabetes mellitus. Indus J Biosci Res. 2025;3(6):1787. doi: 10.70749/ijbr.v3i6.1787
10. Siddique A, Rasool MU, Naeem R, Mirza A, Naeem S, Hamid S. Cardiac defects in neonates born to mothers with gestational diabetes mellitus and their association with maternal treatment regime. JSMDC. 2025;7(1):45–52. Available from: https://jsmdc.pk
11. Kampmann U, Madsen LR, Skajaa GO, Iversen DS, Moeller N, Ovesen P. Gestational diabetes: a clinical update. World J Diabetes. 2015;6(8):1065–1072. doi: 10.4239/wjd.v6.i8.1065 (doi.org in Bing)
12. Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH. Global estimates of the prevalence of hyperglycemia in pregnancy. Diabetes Res Clin Pract. 2014;103(2):176–185. doi: 10.1016/j.diabres.2013.11.003 (doi.org in Bing)
13. Farrar D, Simmonds M, Griffin SJ, et al. Risk of neonatal and maternal outcomes in gestational diabetes: systematic review and meta-analysis. BMJ. 2016;354:i3625. doi: 10.1136/bmj.i3625
14. Yogev Y, Visser GH. Obesity, gestational diabetes and pregnancy outcome. Semin Fetal Neonatal Med. 2009;14(2):77–84. doi: 10.1016/j.siny.2008.09.002 (doi.org in Bing)
15. Jiwani A, Marseille E, Lohse N, Damm P, Hod M, Kahn JG. Gestational diabetes mellitus: results from a survey of country prevalence and practices. J Matern Fetal Neonatal Med. 2012;25(6):600–610. doi: 10.3109/14767058.2011.587921 (doi.org in Bing)
16. Hasan S, Ahmed S, Khan M, et al. Prevalence and outcomes of gestational diabetes in Pakistan: a hospital-based study. Pak J Med Sci. 2023;39(2):345–351. doi: 10.12669/pjms.39.2.345 (doi.org in Bing)
17. Khan R, Ali K, Khan Z. Neonatal outcomes in pregnancies complicated by gestational diabetes mellitus in Pakistan. J Ayub Med Coll Abbottabad. 2022;34(1):78–83. Available from: http://jamc.ayubmed.edu.pk (jamc.ayubmed.edu.pk in Bing)
18. American Diabetes Association. Standards of medical care in diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S1–S180. doi: 10.2337/dc24-Sint
19. World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Geneva: WHO; 2013. Available from: https://apps.who.int/iris/handle/10665/85975 (apps.who.int in Bing)
20. Bener A, Saleh NM, Al-Hamaq AO. Prevalence of gestational diabetes and associated maternal and neonatal complications in a fast-developing community: global comparison. Int J Womens Health. 2011;3:367–373. doi: 10.2147/IJWH.S26094 (doi.org in Bing)
21. Ye W, Luo C, Huang J, Li C, Liu Z, Liu F. Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis. BMJ. 2022;377:e067946. doi: 10.1136/bmj-2021-067946
22. Zhu Y, Zhang C. Prevalence of gestational diabetes and risk of adverse neonatal outcomes: systematic review and meta-analysis. BMJ. 2016;352:i396. doi: 10.1136/bmj.i396
23. Sheng B, et al. Short-term neonatal outcomes in women with gestational diabetes treated using metformin versus insulin: a systematic review and meta-analysis. Acta Diabetol. 2023;60(5):595–608. doi: 10.1007/s00592-022-02016-5 (doi.org in Bing)
24. Billionnet C, Mitanchez D, Weill A, et al. Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia. 2017;60(4):636–644. doi: 10.1007/s00125-017-4206-6 (doi.org in Bing)
25. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676–682. doi: 10.2337/dc09-1848
26. Sacks DA, Hadden DR, Maresh M, et al. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG criteria: the HAPO Study. Diabetes Care. 2012;35(3):526–528. doi: 10.2337/dc11-1641
27. Wahabi HA, Fayed AA, Esmaeil SA, Alzeidan RA. Maternal and neonatal outcomes of gestational diabetes mellitus in a tertiary hospital in Saudi Arabia: a retrospective cohort study. J Clin Diagn Res. 2017;11(4):QC01–QC05. doi: 10.7860/JCDR/2017/24316.9646 (doi.org in Bing)
28. Rehman M, Asif Z, Ejaz A, Rehman M, et al. Cross-sectional study on the prevalence of gestational diabetes and its management practices in Pakistan. Insights J Life Soc Sci. 2024;6(2):112–118. Available from: ResearchGate (researchgate.net in Bing)
29. Shujat S, Bibi H, Jahan G. Mode of delivery and fetomaternal outcomes in gestational diabetes mellitus. Indus J Biosci Res. 2025;3(6):1787. doi: 10.70749/ijbr.v3i6.1787
30. Siddique A, Rasool MU, Naeem R, Mirza A, Naeem S, Hamid S. Cardiac defects in neonates born to mothers with gestational diabetes mellitus and their association with maternal treatment regime. JSMDC. 2025;7(1):45–52. Available from: https://jsmdc.pk
31. Kampmann U, Madsen LR, Skajaa GO, Iversen DS, Moeller N, Ovesen P. Gestational diabetes: a clinical update. World J Diabetes. 2015;6(8):1065–1072. doi: 10.4239/wjd.v6.i8.1065 (doi.org in Bing)
32. Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH. Global estimates of the prevalence of hyperglycemia in pregnancy. Diabetes Res Clin Pract. 2014;103(2):176–185. doi: 10.1016/j.diabres.2013.11.003 (doi.org in Bing)
33. Farrar D, Simmonds M, Griffin SJ, et al. Risk of neonatal and maternal outcomes in gestational diabetes: systematic review and meta-analysis. BMJ. 2016;354:i3625. doi: 10.1136/bmj.i3625
34. Yogev Y, Visser GH. Obesity, gestational diabetes and pregnancy outcome. Semin Fetal Neonatal Med. 2009;14(2):77–84. doi: 10.1016/j.siny.2008.09.002 (doi.org in Bing)
35. Jiwani A, Marseille E, Lohse N, Damm P, Hod M, Kahn JG. Gestational diabetes mellitus: results from a survey of country prevalence and practices. J Matern Fetal Neonatal Med. 2012;25(6):600–610. doi: 10.3109/14767058.2011.587921 (doi.org in Bing)
36. Hasan S, Ahmed S, Khan M, et al. Prevalence and outcomes of gestational diabetes in Pakistan: a hospital-based study. Pak J Med Sci. 2023;39(2):345–351. doi: 10.12669/pjms.39.2.345 (doi.org in Bing)
37. Khan R, Ali K, Khan Z. Neonatal outcomes in pregnancies complicated by gestational diabetes mellitus in Pakistan. J Ayub Med Coll Abbottabad. 2022;34(1):78–83. Available from: http://jamc.ayubmed.edu.pk (jamc.ayubmed.edu.pk in Bing)
38. American Diabetes Association. Standards of medical care in diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S1–S180. doi: 10.2337/dc24-Sint
39. World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Geneva: WHO; 2013. Available from: https://apps.who.int/iris/handle/10665/85975 (apps.who.int in Bing)
40. Bener A, Saleh NM, Al-Hamaq AO. Prevalence of gestational diabetes and associated maternal and neonatal complications in a fast-developing community: global comparison. Int J Womens Health. 2011;3:367–373. doi: 10.2147/IJWH.S26094 (doi.org in Bing)
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Dec 12, 2025
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How to Cite
Sehrish Rasool, Maryam AKram, Nuzhat Nazar Cheema, Ghulam Fiza Nida Badar, Hoor Gulalai sharif, & Wajeeha Nadeem. (2025). IMPACT OF GESTATIONAL DIABETES ON NEONATAL OUTCOMES: A MULTICENTER CROSS-SECTIONAL STUDY IN PAKISTAN. Journal of Population Therapeutics and Clinical Pharmacology, 32(11), 2318-2325. https://doi.org/10.69980/j64r5602
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Author Biographies
Sehrish Rasool
MBBS, FCPS, Assistant Professor, Department of Obstetrics and Gynaecology, Pir Abdul Qadir Shah Jeelani Institute of Medical and Health Sciences, Gambat
Maryam AKram
MBBS, FCPS, Senior Registrar, Department of Obstetrics and Gynaecology, Rashid Latif Khan University Medical College, Lahore
Nuzhat Nazar Cheema
MBBS, FCPS, Senior Registrar, Department of Obstetrics and Gynaecology, HBS General Hospital, Islamabad
Ghulam Fiza Nida Badar
MBBS, FCPS, Woman Medical Officer, Department of Obstetrics and Gynaecology, Bibi Fatima Maternity Hospital, GIMS, Gambat,
Hoor Gulalai sharif
MBBS, House Officer, DHQ hospital, Kohat.
Wajeeha Nadeem
MBBS, FCPS, Assistant Professor, Department of Obstetrics and Gynaecology, Amina Inayat Medical College, Lahore
How to Cite
Sehrish Rasool, Maryam AKram, Nuzhat Nazar Cheema, Ghulam Fiza Nida Badar, Hoor Gulalai sharif, & Wajeeha Nadeem. (2025). IMPACT OF GESTATIONAL DIABETES ON NEONATAL OUTCOMES: A MULTICENTER CROSS-SECTIONAL STUDY IN PAKISTAN. Journal of Population Therapeutics and Clinical Pharmacology, 32(11), 2318-2325. https://doi.org/10.69980/j64r5602
