Gestational diabetes mellitus and fetomaternal outcomes: a study of obstetric and neonatal complications in a tertiary care setting

Background: Gestational diabetes mellitus (GDM) is associated with major maternal and neonatal complications contributing to perinatal morbidity. This study evaluated fetomaternal outcomes and predictors of adverse neonatal outcomes among women with GDM. Methods: This prospective observational study was conducted at Sylhet MAG Osmani Medical College Hospital, Bangladesh, from January to December 2025. A total of 120 pregnant women with GDM who delivered at the tertiary hospital were included. Participants received either diet therapy alone or diet plus insulin according to glycemic control. Maternal complications, mode of delivery, and neonatal outcomes were recorded. Data were analyzed using SPSS version 26 with descriptive statistics, chi-square tests, and logistic regression. Results: Mean maternal age was 29.8±4.6 years, and 61.7% were multigravida. Treatment consisted of diet alone in 43.3% and diet plus insulin in 56.7%. Maternal complications included pregnancy-induced hypertension (21.7%), preeclampsia (15.0%), and polyhydramnios (18.3%). The cesarean section rate was 53.3%. Neonatal complications included macrosomia (23.3%), hypoglycemia (21.7%), respiratory distress syndrome (15.0%), and NICU admission (28.3%). Compared with the diet-only group, insulin-treated women had significantly higher rates of cesarean delivery (73.5% versus 26.9%, p=0.001), macrosomia (32.4% versus 11.5%, p=0.006), and NICU admission (38.2% versus 15.4%, p=0.005). Independent predictors of NICU admission were maternal age ≥35 years (OR=1.92), BMI≥30 kg/m2 (OR=2.38), insulin therapy (OR=2.76), poor glycemic control (OR=3.12), and preterm delivery (OR=2.54). Conclusions: GDM is associated with substantial maternal and neonatal morbidity, particularly among women requiring insulin therapy, emphasizing the need for strict glycemic control and specialized tertiary-level care.