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Background Prevalence of hyperglycaemia in pregnancy is on the rise. Both gestational diabetes mellitus and pre-existing diabetes mellitus are linked to several maternal and foetal/neonatal complications. We describe the diagnosis, management and maternal, neonatal outcomes of hyperglycaemia in pregnancy and compare these variables between mothers with gestational diabetes mellitus and mothers with pre- existing diabetes mellitus in a rural district of Sri Lanka recovering from the effects of decades of civil war. Methods A retrospective cross sectional descriptive study was conducted among mothers with gestational or pre-existing diabetes with a singleton pregnancy, who delivered in the obstetric ward of district general hospital of Vavuniya from 01/10/2018 to 31/10/2019. Consecutive sampling was used. Results Mean age of the participants (n = 324) was 30.07 ± 4.63 (± SD) years. Post prandial blood glucose was checked in 88.8% during the booking visit. Pre-existing diabetes mellitus was detected in 13.5% of mothers. Medical nutrition therapy alone was used in the management of 54.01% of mothers. Addition of metformin alone was needed in 36.7% and 9.2% required combination therapy with metformin and insulin. There were no maternal deaths, intra uterine deaths or still births. Operative delivery was required in 46.3% of mothers. Birth weight > 3.5kg was observed in 13.3% of newborns. Low birth weight (birth weight < 2.5 kg) was noted in 5.2%. There were no cases of shoulder dystocia. Sixteen (4.93%) babies had minor complications. Post-partum complications were noted only in 7 (2.16%) mothers. Post-partum blood sugar levels were performed in 86.7% mothers. Neonatal complications and low birth weight were significantly higher among mothers with pre-existing diabetes. Conclusions We observed low rates of maternal and neonatal complications among mothers with hyperglycaemia in pregnancy. Re-establishment of public health system in these rural areas in the post-war period probably contributed to this. Mothers with pre-existing diabetes had significantly higher rates of low birth weight and neonatal complications compared to mothers with gestational diabetes mellitus. A significant number of mothers missed post-partum blood sugar testing which is an area that could be improved.

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