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A global view of hypertensive disorders and diabetes mellitus during pregnancy

Nature Reviews Endocrinology volume 18, pages 760–775 (2022)Cite this article

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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.

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.

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Fig. 1: Prevalence of hypertensive disorders of pregnancy (per 100,000 women of childbearing age) in 2019 by WHO region.
Fig. 2: The prevalence of hypertensive disorders of pregnancy by country and region in relation to the sociodemographic index and human development index in 2019.
Fig. 3: Disability-adjusted life years attributable to hypertensive disorders of pregnancy by country and region in relation to the sociodemographic index and human development index in 2019.
Fig. 4: Maternal deaths attributable to hypertensive disorders of pregnancy by country and region in relation to the sociodemographic index and human development index in 2019.
Fig. 5: Prevalence of gestational diabetes mellitus in 2021 by WHO region.
Fig. 6: Prevalence of gestational diabetes mellitus by WHO region.
Fig. 7: Major risk factors for maternal cardiometabolic disorders.

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Author notes

  1. These authors contributed equally: Li Jiang, Kun Tang.

Authors and Affiliations

  1. Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada

    Li Jiang, Kun Tang & Zulfiqar A. Bhutta

  2. Vanke School of Public Health, Tsinghua University, Beijing, China

    Kun Tang, Xuan Li & Enyao Zhang

  3. Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK

    Laura A. Magee & Peter von Dadelszen

  4. Department of Obstetrics and Gynecology, Wellington School of Medicine, University of Otago, Wellington, New Zealand

    Alec Ekeroma

  5. National University of Samoa, Apia, Samoa

    Alec Ekeroma

  6. Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan

    Zulfiqar A. Bhutta

  7. Institute for Global Health & Development, the Aga Khan University, Karachi, Pakistan

    Zulfiqar A. Bhutta

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  1. Li Jiang
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Contributions

Z.A.B. and L.J. researched data for the article. Z.A.B., L.J., K.T. and P.v.D. contributed substantially to discussion of the content. All authors wrote the article. All authors reviewed and/or edited the manuscript before submission.

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Jiang, L., Tang, K., Magee, L.A. et al. A global view of hypertensive disorders and diabetes mellitus during pregnancy. Nat Rev Endocrinol 18, 760–775 (2022). https://doi.org/10.1038/s41574-022-00734-y

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