A global view of hypertensive disorders and diabetes mellitus during pregnancy

Abstract

Two important maternal cardiometabolic disorders (CMDs), hypertensive disorders in pregnancy (HDP) (including pre-eclampsia) and gestational diabetes mellitus (GDM), result in a large disease burden for pregnant individuals worldwide. A global consensus has not been reached about the diagnostic criteria for HDP and GDM, making it challenging to assess differences in their disease burden between countries and areas. However, both diseases show an unevenly distributed disease burden for regions with a low income or middle income, or low-income and middle-income countries (LMICs), or regions with lower sociodemographic and human development indexes. In addition to many common clinical, demographic and behavioural risk factors, the development and clinical consequences of maternal CMDs are substantially influenced by the social determinants of health, such as systemic marginalization. Although progress has been occurring in the early screening and management of HDP and GDM, the accuracy and long-term effects of such screening and management programmes are still under investigation. In addition to pharmacological therapies and lifestyle modifications at the individual level, a multilevel approach in conjunction with multisector partnership should be adopted to tackle the public health issues and health inequity resulting from maternal CMDs. The current COVID-19 pandemic has disrupted health service delivery, with women with maternal CMDs being particularly vulnerable to this public health crisis.

Abstract

Two maternal cardiometabolic disorders, hypertensive disorders in pregnancy (HDP) and gestational diabetes mellitus (GDM), affect many pregnant individuals worldwide. This Review discusses the global disease burden and risk factors for HDP and GDM and discusses public health interventions that might help reduce the associated mortality and morbidity.

Key points

• Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are common cardiometabolic complications of pregnancy.

• HDP and GDM show an unevenly distributed disease burden (in terms of prevalence, disability-adjusted life years and/or maternal deaths) in low-income and middle-income countries and/or regions with low sociodemographic and human development indexes.

• In addition to common clinical, demographic and behavioural risk factors, the development and clinical consequences of HDP and GDM are substantially influenced by the socioeconomic determinants of health.

• Besides prevention and treatment at the individual level, strategies should also be made at different levels and in conjunction with multisector partnerships to improve societal and community conditions to prevent and/or manage HDP and GDM.