Date: 22 Apr 2026
Diabetes during pregnancy is no longer a niche concern for specialists. It is a global public health emergency and in South Asia, it is hitting harder than almost anywhere else in the world. At a recent meeting of the Pregnancy Study Group, leading diabetes experts gathered to discuss the latest evidence, guidelines, and emerging approaches to hyperglycemia in pregnancy. The picture that emerged was both alarming and hopeful.
According to data from the International Diabetes Federation (IDF) Atlas, gestational diabetes mellitus (GDM) affects an estimated 14% of pregnancies globally, with a combined estimated prevalence of 10.13%. But the numbers are far from uniform. The highest rates are concentrated in the Middle East and Asia, while Ireland reports one of the lowest prevalences at just 2.07%.
What makes this data particularly troubling is how incomplete it is. Of 221 data sources drawn from 131 countries, only 37 countries had reportable data and only three of those were from Africa. This means the true burden of GDM, particularly in low- and middle-income countries, is likely being significantly underestimated.
In India specifically, the prevalence varies considerably across regions, influenced by socioeconomic status, demographic factors, and differences in study methodology. South Asian women also face higher rates of adverse pregnancy outcomes including pre-eclampsia, caesarean delivery, macrosomia, low birth weight, and intrauterine growth restriction (IUGR).
One of the most contested areas in GDM management is diagnosis. Multiple criteria exist globally, and there is still no universal consensus. The IADPSG criteria which uses a fasting value of 5.1 mmol/L consistently identifies higher GDM prevalence than other criteria and has demonstrated better sensitivity for detecting cases linked to adverse outcomes.
India has responded to this challenge with the DIPSI criteria, a home-grown, one-step non-fasting approach that has simplified screening considerably and made the lives of clinicians across the country much easier. Despite this, over 58% of healthcare professionals in Asia, Africa, and the Middle East still use a two-step screening process first a challenge test, then a confirmatory glucose tolerance test.
On World Diabetes Day 2025, the WHO released new guidelines with 27 recommendations on diabetes in pregnancy, covering glucose monitoring, pharmacological treatment, and antenatal assessment. Notably, WHO recommends continuous glucose monitoring (CGM) for pregnant women with Type 1 diabetes but does not recommend its routine use for those with Type 2 or GDM.
Conventionally, GDM screening has been recommended between 24 to 28 weeks of pregnancy. But emerging evidence is pushing that window earlier much earlier. Experts at the meeting highlighted that gestational diabetes can now be identified as early as 8 weeks of pregnancy, and the term "Early GDM" is being increasingly used for cases detected before 20 weeks.
A landmark randomised controlled trial published in the New England Journal of Medicine provided the first proof that treating early GDM is both beneficial and cost-effective with the most significant results seen in women screened before 14 weeks and those with higher glycemic levels. India's own ICMR InDiab study has reinforced this, showing a high prevalence of early GDM and underscoring the need to screen all pregnant women from the very first antenatal visit.
However, caution is warranted. A systematic review and meta-analysis of 13 cohort studies found that intensive treatment of early GDM may increase neonatal hypoglycemia risk. The challenge is a delicate balance particularly in India, where malnutrition remains prevalent. If mean plasma glucose falls below 87 mg/dL, there is a risk of IUGR; above 104 mg/dL, macrosomia becomes a concern.
Perhaps the most underappreciated aspect of GDM care is what happens after delivery. Once blood glucose normalises post-birth, many women are simply told "you're fine now." This is a missed opportunity and a dangerous one.
Women who have had GDM carry a 50% cumulative risk of developing Type 2 diabetes within 5 to 10 years. They also face significantly higher cardiovascular risk, metabolic syndrome, and hypertension. The WHO and expert bodies recommend formal oral glucose tolerance testing at 6–12 weeks postpartum and regular follow-up every 3 years thereafter. Yet in practice, most women return to clinics only years later already with frank diabetes.
Postpartum glucose assessment is not a formality. It is a critical window for prevention.
Technology and newer therapies are offering fresh hope. CGM, insulin pump therapy, hybrid closed-loop systems, and AI-driven decision support are transforming diabetes management in pregnancy. GLP-1 receptor agonists are under investigation for post-GDM diabetes prevention. Metformin, already widely used, is gaining increasing global acceptance including from FIGO and the ADA as a first-line option for GDM management, particularly in resource-limited settings.
The message from experts is clear: screen early, treat thoughtfully, monitor continuously, and never lose sight of the woman after delivery. For India, a country bearing one of the highest burdens of gestational diabetes in the world, building robust systems for early detection and long-term follow-up is not optional it is urgent.