Gestational diabetes mellitus is generally understood as hyperglycaemia first recognised during pregnancy, although diagnostic definitions have shifted as evidence has matured. The clinical importance of GDM lies in its double window of risk. It may disturb the index pregnancy through hypertensive disorders, macrosomia, operative delivery, neonatal hypoglycemia, and NICU admission, and it may also identify a mother-child pair at higher future metabolic risk.^[1]

In India, the problem has a particular public health weight. Antenatal women often move between primary centres, private clinics, district hospitals, and tertiary referral units. A diagnostic strategy that needs fasting, multiple samples, and repeated visits can fail simply because it does not fit the realities of crowded outpatient care. The national technical and operational guideline therefore supports universal testing using a single-step 75 g oral glucose test, irrespective of the last meal, with two-hour plasma glucose ≥140 mg/dL taken as diagnostic for GDM.^[2]

International bodies have also emphasised the need for feasible screening models, especially in settings where the background risk of diabetes is high. FIGO has argued for pragmatic GDM screening and care pathways adapted to local resources rather than a single rigid global model.^[3]

The American Diabetes Association continues to recognise that screening, diagnosis, nutritional therapy, glucose monitoring, and pharmacological treatment when needed are central to reducing pregnancy-related morbidity.^[4]

The biological basis for concern is no longer speculative. The Hyperglycemia and Adverse Pregnancy Outcome study demonstrated continuous associations between maternal glucose levels and adverse perinatal outcomes, including birth weight above the 90th percentile, primary caesarean delivery, neonatal hypoglycemia, and elevated cord C-peptide.^[5]

This work strongly influenced later international diagnostic frameworks, including the IADPSG recommendations. Even then, for many Indian clinics, the immediate question remains practical: will a simple DIPSI-based diagnosis identify women who actually experience adverse obstetric or neonatal events?^[6]

The DIPSI method has remained attractive because it compresses screening and diagnosis into one visit. Current DIPSI guidance reaffirms its role in Indian practice, especially where universal antenatal testing is expected but fasting OGTT logistics are difficult.^[7]

Indian work has also supported the single-test approach as economical, acceptable, and implementable in community settings. However, outcome-focused evidence remains important because diagnostic convenience alone is not enough. The test must lead to meaningful risk recognition.^[8]

The present study was therefore conducted to assess fetomaternal outcomes among pregnant women diagnosed with GDM by the DIPSI method in a prospective cohort. The emphasis was deliberately clinical: hypertensive disorders, polyhydramnios, mode of delivery, preterm birth, macrosomia, neonatal hypoglycemia, NICU admission, sepsis, and composite fetomaternal outcome.

MATERIALS AND METHODS

Study Design and Setting

This was a prospective observational study conducted in the Department of Obstetrics and Gynaecology at Maharaja Krishna Chandra Gajapati (MKCG) Medical College, Berhampur, Odisha.

Study Period

The study was conducted over one year from January 2025 to December 2025.

Study Population

The study included 115 pregnant women who underwent DIPSI testing during antenatal care. Gestational age at testing ranged from 24 to 28 weeks.

DIPSI Procedure and Diagnostic Criterion

Each participant was evaluated using the DIPSI method. A 75 g oral glucose load was administered irrespective of the last meal, and venous plasma glucose was measured two hours later. GDM was diagnosed when the two-hour plasma glucose value was ≥140 mg/dL.

Variables Recorded

Maternal age, BMI, parity, gestational age at DIPSI testing, and two-hour plasma glucose value were recorded. Maternal outcomes included hypertensive disorder, preeclampsia, gestational hypertension, polyhydramnios, urinary tract infection, postpartum haemorrhage, induction of labour, LSCS delivery, and any maternal complication. Neonatal and perinatal outcomes included preterm birth, macrosomia defined as birth weight >4 kg, shoulder dystocia, neonatal hypoglycemia, NICU admission, neonatal sepsis, perinatal death, and adverse fetomaternal outcome.

Statistical Analysis

Continuous variables were expressed as mean ± standard deviation. Categorical variables were expressed as frequency and percentage. Women with DIPSI-positive GDM were compared with DIPSI-negative women. Independent-sample t-test was used for continuous variables. Chi-square test or Fisher's exact test was used for categorical variables, as appropriate. A p-value <0.05 was considered statistically significant.

RESULTS

A total of 115 pregnant women were included. DIPSI-positive GDM was diagnosed in 22 women (19.1%), while 93 women (80.9%) were DIPSI-negative. The distribution of DIPSI status is shown in Figure 1.

Donut chart displays the proportion of women with DIPSI-positive GDM and DIPSI-negative status.

The GDM-positive group was older, had higher BMI, and had a higher two-hour plasma glucose value than the DIPSI-negative group. Parity distribution showed a higher proportion of higher-order parity among DIPSI-positive women, although the overall parity distribution did not reach statistical significance. Baseline and glycaemic characteristics are presented in Table 1.

Maternal and obstetric outcomes were observed in both DIPSI-positive and DIPSI-negative women, but several events were proportionately more frequent among those with GDM. Induction of labour, LSCS delivery, polyhydramnios, gestational hypertension, and any maternal complication showed statistically significant differences between the two groups. The distribution of maternal outcomes is summarized in Table 2, and selected maternal events are illustrated in Figure 2.

Pie chart shows event counts for selected maternal and obstetric outcomes. Percentages reflect distribution across displayed events, not cohort prevalence.

Neonatal morbidity also showed a clinically relevant pattern. Neonatal hypoglycemia, macrosomia >4 kg, shoulder dystocia, preterm birth, and neonatal sepsis were proportionately more frequent among DIPSI-positive pregnancies. There was one perinatal death, recorded in the DIPSI-positive group. Neonatal and perinatal outcomes are presented in Table 3 and Figure 3.

Bar chart displays cohort-level prevalence of selected neonatal and perinatal outcomes. Values above bars indicate counts and percentages.

When outcomes were examined across two-hour plasma glucose strata, women with plasma glucose values ≥140 mg/dL showed higher clustering of LSCS delivery, neonatal hypoglycemia, NICU admission, and macrosomia compared with the <140 mg/dL stratum. The glucose-strata distribution is shown in Table 4 and Figure 4.

Grouped histogram-style bar chart displays selected outcome counts across plasma glucose categories.

DISCUSSION

The present study found that 19.1% of antenatal women tested positive for GDM by the DIPSI method. This rate lies within the broad Indian range reported across different regions, risk profiles, and diagnostic strategies. DIPSI-positive women were older, had higher BMI, and showed substantially higher two-hour plasma glucose values than DIPSI-negative women.

Indian data have repeatedly shown that GDM prevalence varies widely by geography, socioeconomic position, maternal age, BMI, and diagnostic method. Balaji et al. reported the usefulness of DIPSI criteria among Asian-Indian women, while also highlighting the need for a feasible approach in Indian antenatal practice.^[9] Swaminathan et al., using large national data, further demonstrated marked heterogeneity in GDM prevalence across Indian subgroups. This variation makes a single prevalence figure less useful than a context-aware interpretation of hospital-based findings.^[10]

The clinical pattern observed here is coherent rather than absolute. Adverse outcomes were observed in both DIPSI-positive and DIPSI-negative women, although several clinically important events were proportionately more frequent in the DIPSI-positive group. This is consistent with real obstetric practice: GDM increases risk, but it does not monopolise risk. Anaemia, hypertensive disease, infection, obstetric history, fetal factors, and institutional delivery practice may also shape outcomes in routine Indian obstetric care.

The utility of DIPSI in Indian settings has been debated. Tripathi et al. cautioned that the non-fasting 75 g glucose load may miss some GDM cases when compared with fasting OGTT-based criteria, particularly because it does not capture isolated fasting hyperglycaemia.^[11]

Conversely, more recent work from Puducherry reported high specificity and almost perfect agreement with WHO 2013 criteria, supporting DIPSI as a practical screening and diagnostic tool in primary-care environments.^[12]

Maternal morbidity in the present cohort was not uniformly distributed. Induction of labour and LSCS delivery were significantly more frequent among DIPSI-positive women. Polyhydramnios and gestational hypertension also showed higher proportional occurrence in the GDM-positive group. These findings resemble routine obstetric experience, where GDM often interacts with suspected fetal size, hypertensive surveillance, and delivery planning.

Neonatal hypoglycemia was one of the clearest neonatal signals, occurring in 31.8% of newborns of DIPSI-positive mothers compared with 1.1% among DIPSI-negative pregnancies. Prakash et al. similarly documented neonatal morbidity among infants of mothers with GDM in an Indian tertiary-care cohort.^[13] The mechanism is familiar: maternal hyperglycaemia can stimulate fetal insulin secretion, and after delivery, withdrawal of placental glucose transfer may precipitate neonatal hypoglycemia. Langer et al. showed that untreated GDM increases perinatal morbidity, strengthening the argument that detection must be followed by active management rather than simple documentation.^[14] Neonatal-focused reviews also emphasise hypoglycemia, macrosomia, respiratory problems, and birth trauma as important concerns in pregnancies complicated by maternal diabetes.^[15]

The glucose-strata analysis adds a practical layer. The <140 mg/dL group was not completely free from complications, but selected adverse outcomes became denser across the diagnostic and higher-glucose strata. This pattern is consistent with the HAPO concept of graded glucose-related risk, even though the present study was not designed as a dose-response modelling study.

The findings also reinforce the value of timely management after diagnosis. Randomised evidence has shown that treatment of GDM can reduce serious perinatal morbidity, supporting the idea that diagnosis is an entry point into nutritional counselling, glucose monitoring, and pharmacological therapy where required.^[16]

This study has limitations. It was hospital-based, and the findings should not be read as community prevalence. The sample remains modest for rare outcomes such as perinatal death and shoulder dystocia. Treatment details, glycaemic control after diagnosis, birth weight as a continuous variable, fetal growth centiles, and postpartum glucose follow-up were not available for detailed analysis. The study also did not compare DIPSI with WHO 2013 or IADPSG criteria. Even so, it provides a practical outcome-oriented view of DIPSI-positive GDM in routine antenatal care.

CONCLUSION

In this prospective observational study, 19.1% of antenatal women tested positive for GDM by the DIPSI method. DIPSI-positive GDM was associated with higher maternal age, higher BMI, higher two-hour plasma glucose values, and a greater proportional burden of induction of labour, LSCS delivery, polyhydramnios, gestational hypertension, neonatal hypoglycemia, macrosomia >4 kg, and selected neonatal complications. These findings support the practical role of DIPSI-based testing in routine antenatal care, especially when followed by timely surveillance and management.

Source of Funding

Nil.

Conflict of Interest

None declared.

REFERENCES

1. World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Geneva: World Health Organization 2013.
2. Ministry of Health and Family Welfare, Government of India. Diagnosis and management of gestational diabetes mellitus: technical and operational guidelines. New Delhi: Ministry of Health and Family Welfare 2018.
3. Hod M, Kapur A, Sacks DA, et al. The International Federation of Gynecology and Obstetrics Initiative on gestational diabetes mellitus: a pragmatic guide for diagnosis, management, and care. Int J Gynaecol Obstet 2015;131 Suppl 3:S173-S211.
4. American Diabetes Association Professional Practice Committee. 15. Management of diabetes in pregnancy: Standards of Care in Diabetes-2025. Diabetes Care 2025;48(Suppl 1):S306-20.
5. HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008;358(19):1991-2002.
6. International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, 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):676-82.
7. Seshiah V, Balaji V, Chawla R, et al. Diagnosis and management of gestational diabetes mellitus guidelines by DIPSI (Revised). Int J Diabetes Dev Ctries 2023;43(4):485-501.
8. Anjalakshi C, Balaji V, Balaji MS, et al. A single test procedure to diagnose gestational diabetes mellitus. Acta Diabetol 2009;46(1):51-4.
9. Balaji V, Balaji M, Anjalakshi C, et al. Diagnosis of gestational diabetes mellitus in Asian-Indian women. Indian J Endocrinol Metab 2011;15(3):187-90.
10. Swaminathan G, Swaminathan A, Corsi DJ. Prevalence of gestational diabetes in India by individual socioeconomic, demographic, and clinical factors. JAMA Netw Open 2020;3(11):e2025074.
11. Tripathi R, Verma D, Gupta VK, et al. Evaluation of 75 g glucose load in non-fasting state [Diabetes in Pregnancy Study Group of India (DIPSI) criteria] as a diagnostic test for gestational diabetes mellitus. Indian J Med Res 2017;145(2):209-14.
12. Pravinraj S, Tajudeen MM, Zala D, Senthil R, et al. Diagnostic accuracy of DIPSI criteria for diagnosing gestational diabetes mellitus in Puducherry. J Family Med Prim Care 2024;13(11):5296-300.
13. Prakash GT, Das AK, Habeebullah S, et al. Maternal and neonatal outcome in mothers with gestational diabetes mellitus. Indian J Endocrinol Metab 2017;21(6):854-8.
14. Langer O, Yogev Y, Most O, Xenakis EM. Gestational diabetes: the consequences of not treating. Am J Obstet Gynecol 2005;192(4):989-97.
15. Mitanchez D, Yzydorczyk C, Simeoni U. What neonatal complications should the pediatrician be aware of in case of maternal gestational diabetes? World J Diabetes 2015;6(5):734-43.
16. Crowther CA, Hiller JE, Moss JR, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005;352(24):2477-86.