Nationwide Prevalence and Risk Determinants of Gestational Diabetes Mellitus in Bangladesh: A Multi-Center Facility-Based Study

Background: Gestational diabetes mellitus (GDM) is a major contributor to adverse maternal, fetal, and long-term metabolic outcomes, but reliable nationally representative data from low- and middle-income countries remain limited. This gap is especially relevant in Bangladesh, where rapid epidemiological transition is underway. Methods: 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. Results: Among 1,194 women with complete OGTT data, GDM prevalence was 18.0%, with an additional 2.7% having diabetes first detected in pregnancy. Marked geographic variations were observed across divisions. No significant urban–rural difference was found, indicating widespread population-level risk. 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. Conclusions: About one in five pregnancies among women accessing antenatal care in Bangladesh is affected by GDM, highlighting a substantial and under-recognized metabolic burden. The absence of socioeconomic and urban–rural gradients suggests that GDM risk is widely distributed across the population. These findings support the need for universal antenatal screening policies.