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

S S et al | DOI: 10.65188/nurexus.1052

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Journal of MedVerse Research & Practice

ISSN: 3107-4278

Burden and Feto-Maternal Effects of Gestational Glucose Intolerance

Among Expectant Mothers

Dr. Swetha S

, Dr. A Indhira

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

DOI: 10.65188/nurexus.1052

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].

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

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

This prospective observational study was carried out in the Department of Obstetrics and Gynecology at

PSP Medical College Hospital and Research Institute over a two-year period from May 2023 to May

2025. Pregnant women attending the antenatal clinic who consented to participate and planned to deliver

at the institution were considered for inclusion. Women younger than 18 years, those already diagnosed

with diabetes mellitus or chronic hypertension, individuals with endocrine, cardiac, or autoimmune

disorders, multiple pregnancies, and those unwilling to provide consent or deliver at the study centre were

excluded. Eligible women between 9 and 16 weeks of gestation were enrolled through convenience

sampling. The required sample size was fixed at 200, based on the estimated prevalence of gestational

glucose intolerance from earlier Indian reports and an allowable error of 5%.

Ethical approval was secured prior to initiation of the study, and written informed consent was obtained

after explaining the research objectives in a language understood by each participant. A structured and

pre-tested proforma was used to document demographic details, obstetric history, medical history, and

findings from general, systemic, and obstetric examinations. All participants underwent a 75 g oral

glucose challenge as recommended by DIPSI, irrespective of their fasting state, and a 2-hour venous

plasma glucose sample was analyzed using the glucose oxidase–peroxidase technique.

Gestational Glucose Intolerance (GGI) was defined as a 2-hour value of 120–139 mg/dL, while

Gestational Diabetes Mellitus (GDM) was diagnosed at values of 140 mg/dL or higher. Repeat screening

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was performed at 24–28 weeks and again at 32–34 weeks. Maternal outcomes were monitored throughout

pregnancy, during labor, and in the postpartum period, while fetal outcomes were recorded at birth and

during the neonatal period. Maternal variables assessed included hypertensive disorders, polyhydramnios,

infections, preterm labor, malpresentation, PROM/PPROM, labor complications, mode of delivery,

postpartum hemorrhage, and puerperal infections. Fetal and neonatal assessments included large-for-

gestational-age status, congenital anomalies, intrauterine death, growth restriction, shoulder dystocia,

birth trauma, neonatal hypoglycemia, respiratory distress syndrome, and hyperbilirubinemia.

Data entry was performed using Microsoft Excel and statistical analysis was conducted with SPSS

version 20. Tests for normality were carried out using the Shapiro–Wilk test; appropriate parametric or

non-parametric tests were applied based on distribution, including the independent t-test, ANOVA,

Mann–Whitney U test, Chi-square test, and Fisher’s exact test. A p-value of ≤0.05 was considered

statistically significant. Data quality was ensured through regular cross-verification by the principal

investigator, and all study procedures adhered strictly to ICMR ethical standards and the approved

protocol.

The present study received ethical approval from the Institutional Ethics Committee of PSP Medical

College Hospital and Research Institute, Kanchipuram (Ref No: IEC/PSPMCHRI-KPM/2024/22691). A

detailed Participant Information Sheet was provided to all participants, and written informed consent was

obtained prior to their enrollment in the study.

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)

6.5

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≥140 (GDM)

1.0

Lost to Follow-up (LTF)

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)

17.5

≥140 (GDM)

12.5

Lost to Follow-up (LTF)

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.

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

DIPSI Values (mg/dL)

Frequency

Percent (%)

<120 (NGT)

32.5

120–139 (GGI)

32.5

≥140 (GDM)

25.0

Lost to Follow-up (LTF)

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

8.0

Neonatal hypoglycaemia

6.0

Hyperbilirubinemia

5.0

Large for gestational age (LGA)

4.0

Small for gestational age (SGA)

3.0

Polyhydramnios

2.5

Shoulder dystocia

2.0

Birth trauma

0.5

Congenital malformations

0.5

Intrauterine death

0.5

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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].

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

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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.

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.

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