Hyperglycaemia in pregnancy is an emerging public health challenge in India, but robust national estimates and risk profiles for gestational diabetes mellitus (GDM) and overt diabetes in pregnancy (DIP) are limited. This study used recent nationwide data to quantify their burden, identify key maternal risk factors and describe patterns of care seeking.

A secondary analysis was conducted of 28,408 currently pregnant women enrolled in the National Family Health Survey 5 (2019–2021), a nationally representative household survey. Random capillary blood glucose values, measured by glucometer, were classified into GDM and DIP using fasting specific and non fasting thresholds, and survey weighted logistic regression was used to estimate adjusted associations between sociodemographic, clinical factors, health seeking behaviour and GDM/DIP.

The weighted and age adjusted prevalence of GDM were 4.2% and 5.4%, respectively, rising markedly with maternal age, while corresponding estimates for DIP were 0.38% and 1.04%. Older age groups and obesity were independently associated with higher odds of GDM, whereas women in the second and third trimesters had lower odds compared with those in the first trimester. Pronounced regional heterogeneity was observed, with higher GDM burden in several central, western and southern states and very low prevalence in northeastern states, and women with higher education and excess weight were more likely to seek care in private facilities.

GDM is common among pregnant women in India, with older and obese women disproportionately affected and marked geographic and socioeconomic differences in both risk and care seeking. Prioritising systematic screening and early management of hyperglycaemia in pregnancy within primary care, alongside targeted interventions for high risk groups, could reduce preventable maternal and neonatal complications at scale.