Nationwide trends and geographic variations of diabetes in pregnancy in Thailand: Epidemiology, neonatal outcomes, and healthcare costs under the universal health coverage scheme (2013–2023)

Diabetes in pregnancy is increasing globally, yet national evidence from Thailand on trends, geographic variation, neonatal outcomes, and healthcare costs remains limited. This study examined temporal trends, regional variation, neonatal complications, and economic burden among beneficiaries of Thailand's Universal Coverage scheme. A nationwide retrospective study was conducted using the National Health Security Office electronic claims database in Thailand from 2013 to 2023. The analysis included 103,536 pregnancies affected by diabetes and 14,051 linked infant records. Temporal trends, provincial geographic variation, neonatal outcomes, and direct medical expenditures were examined. Diabetes in pregnancy increased substantially over the study period. Gestational diabetes mellitus remained predominant, while type 1, type 2, and unspecified diabetes increased after 2020. Healthcare costs rose in parallel. Geographic patterns shifted from minimal provincial differences during 2013–2020 to regional hotspots in central, northeastern, and southern Thailand by 2022–2023. Among infants with available claims records, 87.6% had no complications; neonatal jaundice (9.5%) and congenital malformations (2.3%) were the most common outcomes. Diabetes in pregnancy in Thailand has increased rapidly with emerging regional concentration and rising healthcare costs. Strengthened surveillance, improved data linkage, standardized diagnosis, and targeted regional prevention strategies are needed. • Diabetes in pregnancy increased sharply in Thailand from 2013 to 2023. • Geographic hotspots emerged after 2020 across several provinces. • Neonatal complications were uncommon but clinically important. • Healthcare expenditure increased substantially during the study period.