Gestational diabetes mellitus in India: metabolic burden, clinical gaps, and therapeutic opportunities—a systematic review

Background: Gestational diabetes mellitus (GDM), defined as glucose intolerance with onset or first recognition during pregnancy, poses a significant and growing public health challenge in India. With India housing the world’s largest diabetes population, the rising prevalence of GDM has profound implications for maternal and neonatal health, contributing to complications including preeclampsia, macrosomia, neonatal hypoglycaemia, and increased lifelong risk of type 2 diabetes mellitus (T2DM) for both mother and child. Methods: We conducted a systematic literature search of PubMed, Embase, Google Scholar, and Cochrane Library for studies published between January 2019 and December 2024, with seminal works from 2015–2018. Search terms included “gestational diabetes mellitus”, “India”, “screening”, “prevalence”, “management”, and “health systems”. Eligible studies included peer-reviewed articles, government reports, and systematic reviews focusing on Indian populations. Two reviewers independently screened and extracted data. The PRISMA 2020 framework guided reporting. Results: From 2,847 initial records, 156 studies met the inclusion criteria. GDM prevalence in India ranges from 7.2% to 21.4%, with substantial regional variations. Southern states consistently report higher prevalence (15–22%) compared to northern (10–17%) and eastern regions (8–15%). Key challenges identified include low awareness among pregnant women (32% rural, 58% urban) and healthcare providers, inconsistent adoption of evidence-based guidelines (41% of facilities following standardized protocols), severe resource and infrastructural constraints, and significant socioeconomic barriers. Laboratory facilities for oral glucose tolerance test (OGTT) are available in only 34% of community health centers and 12% of primary health centers. Digital health interventions show promise but face implementation barriers, including limited smartphone penetration (45% in rural areas) and inadequate Accredited Social Health Activist (ASHA) workforce training (34% completion rate). Discussion: Despite the escalating burden of GDM in India, numerous unmet needs persist across the care continuum. This review proposes actionable recommendations, including simplified, cost-effective screening strategies, capacity building, integration into existing maternal health programs, and robust postpartum follow-up systems. Success requires sustained commitment to collaborative research, policy initiatives, and integrated, equitable, and sustainable GDM care approaches.