Prevalence and risk determinants of gestational diabetes mellitus among women attending antenatal care services in Bangladesh: a nationwide multi-center facility-based study

Gestational diabetes mellitus (GDM) is a major contributor to adverse maternal, fetal, and long-term metabolic outcomes, but reliable nationally distributed, clinically ascertained data from low- and middle-income countries remain limited. This gap is especially relevant in Bangladesh, where rapid epidemiological transition is underway. We conducted a nationwide, facility-based cross-sectional study across all eight administrative divisions of Bangladesh using a stratified multistage cluster sampling design. Pregnant women attending antenatal clinics were consecutively recruited between January and December 2025. GDM was diagnosed using the International Association of Diabetes and Pregnancy Study Groups criteria based on a standardized 75-g oral glucose tolerance test (OGTT) with fasting, 1-hour, and 2-hour measurements. All samples were analyzed in a centralized laboratory with strict quality control. Multivariable logistic regression was used to identify independent predictors. Among 1,194 women with complete OGTT data, prevalence of GDM was 18.0% (95% CI 15.9–20.3), while an additional 2.7% of women met criteria for diabetes in pregnancy (DIP), resulting in an overall hyperglycemia in pregnancy prevalence of 20.7%. Marked geographic variations were observed across divisions. No statistically significant urban-rural difference was detected among women attending ANC services. In adjusted analyses, increasing maternal age (aOR 1.05 per year; 95% CI 1.02–1.09), higher pre-pregnancy body mass index (aOR 1.09 per kg/m²; 95% CI 1.05–1.13), and family history of diabetes (aOR 1.78; 95% CI 1.21–2.62) were independently associated with GDM. None of the socioeconomic indicators showed independent association. About one in five pregnancies among women accessing antenatal care in Bangladesh is affected by GDM, highlighting a substantial and under-recognized metabolic burden. We did not detect significant socioeconomic or urban-rural differences in GDM prevalence among ANC attendees, although modest differences cannot be excluded. However, findings should be interpreted in the context of the facility-based design, which may limit generalizability to women not accessing antenatal care services.