Burden and Feto-Maternal Effects of Gestational Glucose Intolerance  Among Expectant Mothers

Swetha, S; Indhira, A

doi:10.65188/nurexus.1052

Page 9

ORIGINAL ARTICLE

Journal of MedVerse Research & Practice

ISSN: 3107-4278

Burden and Feto-Maternal Effects of Gestational Glucose Intolerance

Among Expectant Mothers

Dr. Swetha S

1

, Dr. A Indhira

2

Assistant Professor, Professor

Department of Obstetrics & Gynaecology, PSP Medical College Hospital and

Research Institute, Kanchipuram.

Email ID: swethasivakumar@gmail.com,

Submission Date: 21.10.2025

Accepted Date: 16.11.2025

Published Date: 30.11.2025

article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits

unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Abstract

Background: Pregnancy is associated with progressive insulin resistance, which may lead to gestational glucose

abnormalities. Gestational Glucose Intolerance (GGI), defined as borderline hyperglycemia that does not meet

diagnostic criteria for gestational diabetes mellitus (GDM), has been relatively under-investigated despite potential

feto-maternal risks.

Methods: This prospective observational study included 200 pregnant women attending antenatal care at PSP

Medical College Hospital over two years (May 2023–May 2025). Screening for glucose intolerance was performed

using the DIPSI 75 g oral glucose challenge at first (9–14 weeks), second (24–28 weeks), and third (32–34 weeks)

trimesters. GGI was defined as a 2-hour post-glucose value of 120–139 mg/dL, while GDM was ≥140 mg/dL.

Maternal outcomes (hypertensive disorders, polyhydramnios, preterm labor, mode of delivery, and postpartum

complications) and fetal/neonatal outcomes (respiratory distress, hypoglycemia, hyperbilirubinemia, growth

abnormalities, congenital anomalies, and intrauterine death) were recorded. Data analysis was performed using

SPSS v20, applying appropriate parametric and non-parametric tests.

Results: First-trimester screening revealed 6.5% GGI and 1% GDM, which increased in the second trimester to

17.5% and 12.5%, respectively, and in the third trimester to 32.5% GGI and 25% GDM. Maternal complications

were more common in the GGI and GDM groups. Among GGI pregnancies, notable fetal outcomes included

respiratory distress syndrome (8%), neonatal hypoglycemia (6%), hyperbilirubinemia (5%), and large-for-

gestational-age infants (4%). Rare complications included small-for-gestational-age infants, polyhydramnios,

shoulder dystocia, birth trauma, congenital malformations, and intrauterine death (≤2.5% each).

Conclusion: GGI is a significant and progressive metabolic disturbance in pregnancy, with a measurable

conversion rate to GDM and notable fetal complications. Early detection, repeat screening, and timely intervention

are essential to reduce perinatal morbidity and optimize maternal and neonatal outcomes.

Keywords: Gestational glucose intolerance, gestational diabetes mellitus, DIPSI, pregnancy, maternal outcomes,

fetal outcomes, neonatal complications.

Introduction

Pregnancy is a unique physiological state marked by extensive metabolic and hormonal adjustments that

allow maternal adaptation and support fetal development. A key change is the gradual increase in insulin

resistance during the second and third trimesters, mainly due to placental hormones such as human

placental lactogen, progesterone, cortisol, and prolactin [1]. In most healthy pregnancies, this is balanced

by enhanced pancreatic β-cell insulin secretion, ensuring that blood glucose levels remain normal [2].

When this compensatory mechanism is inadequate, varying degrees of hyperglycemia may occur [3].

Page 10

Traditionally, hyperglycemia in pregnancy has been categorized as gestational diabetes mellitus (GDM)

or diabetes first recognized during pregnancy. Recently, attention has shifted to an intermediate category

termed Gestational Glucose Intolerance (GGI), in which glucose values are elevated but do not meet the

diagnostic criteria for GDM [4]. Although previously overlooked, evidence suggests that GGI may

contribute to maternal complications, adverse perinatal outcomes, and future metabolic disease in both

mother and child [5].

Globally, hyperglycemia affects an estimated 16–18% of pregnancies, with GDM forming the majority of

cases [6]. In India, reported prevalence ranges from 10% to 20%, influenced by population

characteristics, lifestyle transitions, and diagnostic methods used [7]. With rising obesity rates and

increasing incidence of type 2 diabetes, both GGI and GDM have become important public health

concerns [8]. GDM is widely recognized as a major contributor to maternal and neonatal morbidity,

including pregnancy-induced hypertension, operative delivery, neonatal hypoglycemia, macrosomia, and

long-term metabolic risks [9]. In comparison, GGI—defined by the DIPSI criteria as a 2-hour post–75 g

glucose value of 120–139 mg/dL—has received limited attention despite being associated with similar

adverse feto-maternal outcomes [10]. The lack of epidemiological data on GGI incidence and clinical

impact represents a significant gap in obstetric and endocrine practice [11].

Understanding GGI is essential for recognizing the continuum of dysglycemia in pregnancy. Early

identification of borderline glucose intolerance offers an opportunity for timely lifestyle counseling,

closer monitoring, and preventive care, potentially reducing progression to GDM and future diabetes risk

[12]. In India’s high-diabetes-burden setting, generating local data on GGI is crucial to refine screening

strategies, guide clinical decision-making, and inform updates to guidelines developed by WHO, DIPSI,

and ICMR.

Materials and Methods

Study Design

This prospective observational study was conducted to evaluate the prevalence of gestational glucose

intolerance (GGI) and gestational diabetes mellitus (GDM), along with their associated maternal and fetal

outcomes among pregnant women.

Study Setting and Duration

The study was carried out in the Department of Obstetrics and Gynecology at PSP Medical College

Hospital and Research Institute over a period of two years, from May 2023 to May 2025.

Study Population

The study population comprised pregnant women attending the antenatal clinic between 9 and 16 weeks

of gestation who planned to deliver at the study institution. Eligible participants were enrolled using

convenience sampling.

Sample Size

A total of 200 pregnant women were included in the study. The sample size was determined based on

the estimated prevalence of gestational glucose intolerance reported in previous Indian studies, with a 5%

allowable error and a 95% confidence level.

Inclusion Criteria

Pregnant women aged 18 years and above with singleton pregnancies between 9 and 16 weeks of

gestation, willing to participate in the study, provide written informed consent, and deliver at the study

institution were included.

Page 11

Exclusion Criteria

Women younger than 18 years, those with pre-existing diabetes mellitus, chronic hypertension, endocrine

disorders, cardiac diseases, autoimmune disorders, multiple pregnancies, or those unwilling to provide

informed consent or deliver at the study hospital were excluded.

Data Collection Tool

After obtaining written informed consent, demographic characteristics, obstetric history, medical history,

and findings of general, systemic, and obstetric examinations were recorded using a structured pre-tested

case record proforma. All participants underwent a single-step 75 g oral glucose challenge test (OGCT)

according to the Diabetes in Pregnancy Study Group India (DIPSI) guidelines irrespective of fasting

status. Two-hour venous plasma glucose levels were estimated using the glucose oxidase–peroxidase

method. Gestational Glucose Intolerance (GGI) was defined as a two-hour plasma glucose value between

120 and 139 mg/dL, while Gestational Diabetes Mellitus (GDM) was diagnosed when the value was 140

mg/dL or higher. Women with normal initial screening underwent repeat testing at 24–28 weeks and

again at 32–34 weeks of gestation. Participants were prospectively followed throughout pregnancy,

labour, delivery, and the postpartum period. Maternal outcomes assessed included gestational

hypertension, preeclampsia, polyhydramnios, urinary tract infection, premature rupture of membranes

(PROM), preterm premature rupture of membranes (PPROM), preterm labour, malpresentation, labour

complications, mode of delivery, postpartum hemorrhage, puerperal sepsis, and duration of hospital stay.

Neonatal outcomes included birth weight, large-for-gestational-age status, intrauterine growth restriction,

congenital anomalies, intrauterine fetal death, shoulder dystocia, birth trauma, neonatal hypoglycaemia,

respiratory distress syndrome, hyperbilirubinaemia, neonatal intensive care unit admission, and neonatal

mortality.

Ethical Considerations

The study protocol was approved by the Institutional Ethics Committee of PSP Medical College Hospital

and Research Institute prior to commencement of the study. Written informed consent was obtained from

all participants after explaining the study objectives and procedures in their local language.

Confidentiality of participant information was maintained throughout the study by assigning unique

identification numbers. All study procedures were conducted in accordance with the ethical principles of

the Indian Council of Medical Research (ICMR) guidelines and the Declaration of Helsinki.

Statistical Analysis

Data were entered into Microsoft Excel and analyzed using the Statistical Package for the Social Sciences

(SPSS) software version 20.0. Continuous variables were expressed as mean ± standard deviation or

median with interquartile range based on data distribution, while categorical variables were summarized

as frequencies and percentages. Normality of continuous variables was assessed using the Shapiro–Wilk

test. Comparisons between groups were performed using the independent sample t-test or one-way

analysis of variance (ANOVA) for normally distributed variables, and the Mann–Whitney U test for non-

normally distributed variables. Associations between categorical variables were evaluated using the Chi-

square test or Fisher's exact test, as appropriate. Multivariate logistic regression analysis was performed to

identify independent predictors of adverse maternal and neonatal outcomes after adjusting for potential

confounding variables. Odds ratios with 95% confidence intervals were calculated. A p-value of ≤0.05

was considered statistically significant.

Page 12

Results

Figure 1: Obstetric Score (N = 200)

The table shows the distribution of pregnant women based on their obstetric score. Out of the 200

participants, 39% were primigravida (first pregnancy) and 61% were multigravida (having had one or

more previous pregnancies).

Table 1: DIPSI Screening Values – 1st Trimester (9–14 Weeks)

DIPSI Values (mg/dL)

Frequency

Percent (%)

<120 (NGT)

180

90.0

120–139 (GGI)

13

6.5

≥140 (GDM)

2

1.0

Lost to Follow-up (LTF)

5

2.5

Total

200

100.0

Among the 200 pregnant women screened using the DIPSI test, 90% had normal glucose tolerance (NGT)

with values <120 mg/dL. Gestational Glucose Intolerance (GGI) was identified in 6.5%, while

Gestational Diabetes Mellitus (GDM) was detected in 1% of the participants. Additionally, 2.5% were

lost to follow-up.

Table 2: DIPSI Screening Values – 2nd Trimester (24–28 Weeks)

DIPSI Values (mg/dL)

Frequency

Percent (%)

<120 (NGT)

130

65.0

120–139 (GGI)

35

17.5

≥140 (GDM)

25

12.5

Lost to Follow-up (LTF)

10

5.0

Total

200

100.0

Out of the 200 pregnant women screened, 65% had normal glucose tolerance (NGT) with DIPSI values

<120 mg/dL. Gestational Glucose Intolerance (GGI) was observed in 17.5%, and Gestational Diabetes

Mellitus (GDM) in 12.5% of the participants. Additionally, 5% were lost to follow-up.

Page 13

Table 3: DIPSI Screening Values – 3rd Trimester (32–34 Weeks)

DIPSI Values (mg/dL)

Frequency

Percent (%)

<120 (NGT)

65

32.5

120–139 (GGI)

65

32.5

≥140 (GDM)

50

25.0

Lost to Follow-up (LTF)

20

10.0

Total

200

100.0

Among the 200 pregnant women screened using DIPSI, 32.5% had normal glucose tolerance (NGT) with

values <120 mg/dL. An equal proportion, 32.5%, were identified with Gestational Glucose Intolerance

(GGI). Gestational Diabetes Mellitus (GDM) was detected in 25% of the participants, indicating a

considerable burden of hyperglycemia in pregnancy. Additionally, 10% of the women were lost to

follow-up.

Table 4: Fetal Outcomes in GGI Mothers (Adjusted for 200 Samples)

Fetal Outcome

Frequency

Percent (%)

Respiratory distress syndrome

16

8.0

Neonatal hypoglycaemia

12

6.0

Hyperbilirubinemia

10

5.0

Large for gestational age (LGA)

8

4.0

Small for gestational age (SGA)

6

3.0

Polyhydramnios

5

2.5

Shoulder dystocia

4

2.0

Birth trauma

1

0.5

Congenital malformations

1

0.5

Intrauterine death

1

0.5

In the present study, respiratory distress syndrome was the most frequently observed fetal complication,

affecting 8% of newborns. This was followed by neonatal hypoglycaemia (6%) and hyperbilirubinemia

(5%), indicating that metabolic and respiratory issues were relatively common. Growth-related outcomes

included large-for-gestational-age infants (4%) and small-for-gestational-age babies (3%). Less frequent

complications were polyhydramnios (2.5%), shoulder dystocia (2%), and rare events such as birth trauma,

congenital malformations, and intrauterine death (each 0.5%).

Discussion

In our cohort of 200 pregnant women, abnormal glucose tolerance increased progressively with

advancing gestation. Gestational glucose intolerance (GGI) and gestational diabetes mellitus (GDM)

were uncommon in the first trimester (approximately 7.5%), but by 24–28 weeks, nearly 30% of

women had GGI or GDM, and by 32–34 weeks, the combined burden rose to about 57.5%. This

progressive rise is consistent with the pathophysiological understanding that insulin resistance

increases during the second and third trimesters due to placental hormone effects, as outlined by

McIntyre et al. [1] and Zhu and Zhang [2]. Similar Indian hospital-based studies have reported a rising

prevalence of carbohydrate intolerance across gestation, with approximately one-third of women

screened in mid-pregnancy diagnosed with GGI or GDM, comparable to our findings, as reported by

Huvinen et al. [13] and Agarwal [14].

Page 14

The observed conversion from GGI to GDM in our cohort (11% overall, with higher conversion in

later trimesters) aligns with previous literature indicating that a proportion of women with borderline

hyperglycemia progress to overt GDM as pregnancy advances. Longitudinal evidence suggests that

early glucose abnormalities represent a risk marker for later deterioration, reinforcing the need for

repeat screening rather than reliance on a single early test. These observations are consistent with

diagnostic and follow-up recommendations described by the World Health Organization [15] and the

IADPSG Consensus Panel [16]. Fetal morbidity in our GGI group was notable, particularly respiratory

distress syndrome (8%) and neonatal hypoglycemia (6%). Similar associations between mild

gestational hyperglycemia and adverse neonatal outcomes have been reported previously. Barquiel et

al. [5] documented increased neonatal complications in women with isolated abnormal glucose values,

while Li et al. [7] demonstrated a higher risk of neonatal respiratory distress syndrome among infants

born to mothers with gestational dysglycemia. These findings support earlier observations from the

HAPO study by Metzger et al. [9], which showed a continuous relationship between maternal

glycemia and adverse perinatal outcomes, even below traditional diagnostic thresholds, reinforcing

that GGI is not a benign condition.

Variations between our prevalence estimates and those reported in other studies may be explained by

methodological differences. Diagnostic criteria and screening protocols vary widely; the DIPSI one-

step non-fasting 75 g glucose test used in our study may yield prevalence estimates that differ from

IADPSG or WHO-based approaches. Comparative analyses have highlighted that DIPSI may under-

or overestimate GDM prevalence depending on population characteristics and timing of testing, as

discussed by Agarwal [14] and Seshiah et al. [18]. Additionally, tertiary referral bias, maternal age

distribution, body mass index, and ethnic or regional factors may further contribute to differences in

reported rates, explaining the relatively higher third-trimester burden observed in our cohort compared

with community-based studies. Overall, our findings support the growing body of evidence that

borderline hyperglycemia in pregnancy (GGI) carries significant perinatal risk and a meaningful

likelihood of progression to GDM. This underscores the importance of repeat screening, vigilant

follow-up, and timely lifestyle or pharmacological intervention when indicated, particularly in

populations with a high baseline risk of diabetes. These conclusions are consistent with

recommendations from the American Diabetes Association [6,17] and conceptual frameworks

proposed by Gupta et al. [10]. Future studies should incorporate longitudinal glycemic control data

and adjust for confounding variables such as maternal BMI, age, and treatment modality to better

delineate the independent contribution of GGI to adverse neonatal outcomes.

Strengths

This prospective study utilized the standardized DIPSI screening protocol with repeated glucose

testing at different stages of pregnancy, enabling early identification of gestational glucose intolerance

and gestational diabetes mellitus. Comprehensive follow-up throughout pregnancy, delivery, and the

neonatal period allowed detailed assessment of both maternal and fetal outcomes.

Limitations

The study was conducted at a single tertiary care institution using convenience sampling, which may

limit the generalizability of the findings. In addition, long-term maternal metabolic outcomes and

childhood follow-up after birth were not assessed, limiting evaluation of the long-term impact of

gestational glucose intolerance and gestational diabetes mellitus.

Page 15

Conclusion

In this study of 200 pregnant women, gestational glucose abnormalities increased across trimesters,

with GGI progressing to GDM in some cases. GGI was associated with notable fetal complications,

including respiratory distress, neonatal hypoglycemia, and hyperbilirubinemia. These findings

emphasize the importance of early detection, repeat screening, and timely intervention to improve

maternal and neonatal outcomes.

Conflict of interest: Nil

Source Of Fund: Nil

Acknowledgement: I extend my sincere gratitude to my department for their support throughout the

study, and to the institution’s management for enabling the successful completion of this work.

Reference

1. McIntyre HD, Catalano P, Zhang C, Desoye G, Mathiesen ER, Damm P. Gestational diabetes mellitus. Nat

Rev Dis Primers. 2019;5(1):47.

2. Zhu Y, Zhang C. Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global

perspective. Curr Diab Rep. 2016;16(1):7.

3. Akbarzadeh N, Moazzeni SS, Farhadian M, et al. National and regional prevalence of gestational diabetes

mellitus: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2024;24:85.

4. Venkatesan P, Narasingan S, Sivakumar S. Prevalence and predictors of gestational diabetes mellitus in

South India. J Obstet Gynaecol India. 2024;74(2):112-8.

5. Barquiel B, Herranz L, Hillman N, Burgos MA, Grande C, Pallardo LF. Fetal and maternal outcomes in

women with isolated abnormal values in the oral glucose tolerance test. Diabetes Res Clin Pract.

2023;196:110543.

6. American Diabetes Association. Standards of Care in Diabetes—2025. Diabetes Care. 2025;48(Suppl

1):S167-80.

7. Li Y, Liu G, Xu L, et al. Gestational diabetes mellitus and risk of neonatal respiratory distress syndrome: a

meta-analysis. Diabetes Metab Syndr Obes. 2024;17:1101-12.

8. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes risk after gestational diabetes: a

systematic review and meta-analysis. Lancet. 2009;373(9677):1773-9.

9. Metzger BE, Lowe LP, Dyer AR, et al. Hyperglycemia and adverse pregnancy outcomes (HAPO Study). N

Engl J Med. 2008;358(19):1991-2002.

10. Gupta Y, Kalra B, Baruah MP. Gestational glucose intolerance: An emerging entity in obstetrics. Diabetes

Ther. 2018;9(5):2101-2113.

11. American Diabetes Association. Standards of Medical Care in Diabetes—2022. Diabetes Care.

2022;45(Suppl 1):S244–S253.

12. Zhu Y, Zhang C. Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global

perspective. Curr Diab Rep. 2018;18(10):1–8.

13. Huvinen E, Eriksson JG, Koivusalo SB, Stach-Lempinen B, Tiitinen A, Rönö K. Borderline glucose

intolerance in pregnancy and its impact on maternal and neonatal outcomes. Acta Obstet Gynecol Scand.

2018;97(6):701–708.

14. Agarwal MM. Gestational glucose intolerance: The Indian perspective. Diabetes Res Clin Pract.

2020;162:108091.

15. World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its

complications. Geneva: WHO; 1999.

16. International Association of Diabetes and Pregnancy Study Groups (IADPSG) Consensus Panel.

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.

17. American Diabetes Association. Classification and diagnosis of diabetes: Standards of Medical Care in

Diabetes—2022. Diabetes Care. 2022;45(Suppl 1):S17–S38.

Page 16

18. Seshiah V, Balaji V, Balaji MS, Paneerselvam A, Arthi T, Thamizharasi M, et al. Diagnosis of gestational

diabetes mellitus in the community. J Assoc Physicians India. 2018;66(5):34–36.