Punnose J. Maternal and neonatal outcomes according to the timing of diagnosis of gestational diabetes: A critical appraisal. World J Diabetes 2025; 16(10): 108254 [PMID: 41113499 DOI: 10.4239/wjd.v16.i10.108254]
Corresponding Author of This Article
John Punnose, MD, Chief Physician, Dean, Department of Endocrinology and Metabolism, St. Stephen’s Hospital, Tis Hazari, Delhi 110054, India. drpunnose@rediffmail.com
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Endocrinology & Metabolism
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Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Oct 15, 2025 (publication date) through Oct 22, 2025
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World Journal of Diabetes
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1948-9358
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Punnose J. Maternal and neonatal outcomes according to the timing of diagnosis of gestational diabetes: A critical appraisal. World J Diabetes 2025; 16(10): 108254 [PMID: 41113499 DOI: 10.4239/wjd.v16.i10.108254]
World J Diabetes. Oct 15, 2025; 16(10): 108254 Published online Oct 15, 2025. doi: 10.4239/wjd.v16.i10.108254
Maternal and neonatal outcomes according to the timing of diagnosis of gestational diabetes: A critical appraisal
John Punnose
John Punnose, Department of Endocrinology and Metabolism, St. Stephen’s Hospital, Delhi 110054, India
Author contributions: Punnose J conceptualized the topic, reviewed literature, and prepared the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: John Punnose, MD, Chief Physician, Dean, Department of Endocrinology and Metabolism, St. Stephen’s Hospital, Tis Hazari, Delhi 110054, India. drpunnose@rediffmail.com
Received: April 9, 2025 Revised: May 11, 2025 Accepted: September 11, 2025 Published online: October 15, 2025 Processing time: 189 Days and 18 Hours
Abstract
Gestational diabetes mellitus (GDM) is the most common metabolic abnormality of pregnancy and is associated with early and late adverse outcomes for both mothers and fetuses. Conventionally, GDM is diagnosed between 24 and 28 gestational weeks (GW) (late-onset GDM). With the increasing prevalence of prediabetes among women of reproductive age, GDM is increasingly being diagnosed before 24 GW in high-risk populations (early-onset GDM). Compared with late-onset GDM pregnancies, early-onset GDM pregnancies are at greater risk for neonatal adverse events, such as perinatal mortality, neonatal hypoglycemia, neonatal respiratory distress syndrome, and macrosomia. The TOBOGM study revealed that the initiation of treatment before 20 GW can modestly reduce composite neonatal outcomes, mainly due to a reduction in the rate of neonatal respiratory distress syndrome. The benefit was greater when treatment was initiated before 14 GW. The probable mechanisms for early-onset hyperglycemia-induced neonatal adverse events are decidual and placental defects, interference with fetal lung development, and fetal glucose steal. There is no international consensus on the GDM screening strategy in early pregnancy, and its cost-effectiveness is questioned by several professional bodies. Further prospective randomized controlled studies are strongly recommended to alleviate confusion in clinical practice regarding the management of mild hyperglycemia in early pregnancy.
Core Tip: Gestational diabetes mellitus (GDM) is the most common metabolic abnormality of pregnancy and is associated with early and late adverse outcomes for both mothers and fetuses. Hyperglycemia that satisfies the GDM diagnostic criteria is increasingly being identified in early pregnancy [early-onset GDM (E-GDM)]. Despite treatment, adverse pregnancy events are more common in E-GDM than in late-onset GDM. The TOBOGM study revealed a significant reduction in adverse neonatal events, especially neonatal respiratory distress syndrome, when GDM treatment was initiated in early pregnancy and reported the cost-effectiveness of this strategy. More prospective randomized controlled trials are needed to develop an internationally accepted criterion for E-GDM diagnosis.
