The dual burden of gestational diabetes mellitus and hypertensive disorders of pregnancy: A prospective cohort study

Abstract

Background: Gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are among the leading medical complications of pregnancy and share common pathophysiological mechanisms such as insulin resistance, endothelial dysfunction, and chronic inflammation. The coexistence of these conditions significantly increases maternal and perinatal morbidity. This study aimed to evaluate the incidence of HDP in women diagnosed with GDM and to analyse associated maternal and perinatal outcomes.Methods: This prospective cohort study was conducted in the Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Raipur, from January 2024 to June 2025. Pregnant women aged 19-35 years with singleton pregnancies diagnosed with GDM at 24-28 weeks of gestation using Diabetes in Pregnancy Study Group India (DIPSI)/ International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria were enrolled and followed until six weeks postpartum. Women with overt diabetes, chronic hypertension, obesity, polycystic ovary syndrome, renal disease, and multiple gestations were excluded. Participants were monitored for the development of HDP as per International Society for the Study of Hypertension in Pregnancy (ISSHP) guidelines. Maternal characteristics, gestational weight gain, mode of delivery, and perinatal outcomes were recorded and analysed.Results: The enrolled women who completed follow-up, 13.4% developed hypertensive disorders of pregnancy. Preeclampsia constituted the majority of HDP cases, followed by gestational hypertension. Excessive gestational weight gain showed a statistically significant association with the development of HDP, whereas demographic and socioeconomic factors did not demonstrate a significant correlation. Women with GDM who developed HDP had higher rates of obstetric interventions and adverse perinatal outcomes compared to those without hypertension.Conclusion: GDM is associated with a substantial risk of developing hypertensive disorders of pregnancy, particularly preeclampsia. Early identification of high-risk women, optimal glycaemic control, appropriate weight management, and close antenatal surveillance are essential to reduce hypertensive complications and improve maternal and perinatal outcomes.