Association between gestational diabetes mellitus and risk of preeclampsia: a prospective observational case-control study in a tertiary care setting in Central India
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20252338Keywords:
Gestational diabetes mellitus, Preeclampsia, Pregnancy complications, Insulin therapy, Glycemic control, Risk assessment, Antenatal careAbstract
Background: Preeclampsia (PE) is a hypertensive disorder with significant maternal and fetal morbidity, often developing after 20 weeks of gestation. Gestational diabetes mellitus (GDM) is a common metabolic complication of pregnancy that shares pathophysiological mechanisms with PE, such as endothelial dysfunction and oxidative stress. This study aimed to assess the risk and correlation of preeclampsia in women diagnosed with GDM in a tertiary care setting in central India.
Methods: A prospective, observational, case-control study was conducted over two months in the Department of Obstetrics and Gynecology. A total of 248 pregnant women were enrolled and categorized into two equal groups: GDM and control. Data were collected on glycemic profiles, blood pressure, and incidence of preeclampsia at baseline and after eight weeks. Statistical analysis included unpaired t-tests and Pearson correlation coefficients.
Results: The incidence of preeclampsia was significantly higher in the GDM group (25.79%) compared to the control group (10.4%), with an odds ratio of 2.96 and a relative risk of 2.48. A positive correlation was observed between worsening glycemic parameters and the development of preeclampsia. The GDM group also required more pharmacological interventions, including insulin and antihypertensives.
Conclusions: GDM significantly increases the risk of preeclampsia. Early screening, close monitoring, and tailored management of GDM are essential in mitigating maternal and fetal complications associated with hypertensive disorders in pregnancy.
Metrics
References
Fox R, Kitt J, Leeson P, Aye CYL, Lewandowski AJ. Preeclampsia: Risk Factors, Diagnosis, Management, and the Cardiovascular Impact on the Offspring. J Clin Med. 2019;8(10):1625. DOI: https://doi.org/10.3390/jcm8101625
Malik A, Jee B, Gupta SK. Preeclampsia: Disease biology and burden, its management strategies with reference to India. Pregnancy Hypertens. 2019;15:23-31. DOI: https://doi.org/10.1016/j.preghy.2018.10.011
Nobis PN, Hajong A. Eclampsia in India through the decades. J Obstet Gynecol India. 2016;66:172-6. DOI: https://doi.org/10.1007/s13224-015-0807-5
Kautzky-Willer A, Bancher-Todesca D, Birnbacher R. Gestationsdiabetes (GDM) [Gestational diabetes mellitus]. Acta Med Austriaca. 2004;31(5):182-4.
American Diabetes Association. 13. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S137-43. DOI: https://doi.org/10.2337/dc18-S013
Phoswa WN, Khaliq OP. The role of oxidative stress in hypertensive disorders of pregnancy. Oxid Med Cell Longev. 2021;2021:1. DOI: https://doi.org/10.1155/2021/5581570
Vounzoulaki E, Khunti K, Abner SC, Tan BK, Davies MJ, Gillies CL. Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. BMJ. 2020;369:m1361. DOI: https://doi.org/10.1136/bmj.m1361
Mongraw-Chaffin ML, Cirillo PM, Cohn BA. Preeclampsia and cardiovascular disease death: prospective evidence from the child health and development studies cohort. Hypertension. 2010;56(1):166-71. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.110.150078
Yang Y, Wu N. Gestational diabetes mellitus and preeclampsia: correlation and influencing factors. Front Cardiovasc Med. 2022;9:831297. DOI: https://doi.org/10.3389/fcvm.2022.831297
Sermer M, Naylor CD, Farine D, Kenshole AB. The Toronto tri-hospital gestational diabetes project: a preliminary review. Diabetes Care. 1998;21:B33.
Phaloprakarn C, Tangjitgamol S. Risk assessment for preeclampsia in women with gestational diabetes mellitus. J Perinat Med. 2009;37(6):617-21. DOI: https://doi.org/10.1515/JPM.2009.108
Zhou Z, Deng C, Xiang X. Blood glucose related to pregnancy induced hypertension syndrome. Am J Transl Res. 2021;13(5):5301-7.
Gathiram P, Moodley JJ. Pre-eclampsia: its pathogenesis and pathophysiology: review articles. Cardiovasc J Afr. 2016;27(2):71-8. DOI: https://doi.org/10.5830/CVJA-2016-009
McElwain CJ, Tuboly E, McCarthy FP, McCarthy CM. Mechanisms of Endothelial Dysfunction in Pre-eclampsia and Gestational Diabetes Mellitus: Windows Into Future Cardiometabolic Health? Front Endocrinol (Lausanne). 2020;11:655. DOI: https://doi.org/10.3389/fendo.2020.00655
Gui J, Liu Q, Feng L. Metformin vs insulin in the management of gestational diabetes: a meta-analysis. PLoS One. 2013;8(5):e64585. DOI: https://doi.org/10.1371/journal.pone.0064585
Buhary BM, Almohareb O, Aljohani N, Alzahrani SH, Elkaissi S, Sherbeeni S, et al. Glycemic control and pregnancy outcomes in patients with diabetes in pregnancy: A retrospective study. Indian J Endocrinol Metab. 2016;20(4):481-90. DOI: https://doi.org/10.4103/2230-8210.183478
Barden A, Singh R, Walters BN, Ritchie J, Roberman B, Beilin LJ. Factors predisposing to pre-eclampsia in women with gestational diabetes. J Hypertens. 2004;22(12):2371-8. DOI: https://doi.org/10.1097/00004872-200412000-00020
Pankiewicz K, Szczerba E, Fijałkowska A, Sierdziński J, Issat T, Maciejewski TM. The Impact of Coexisting Gestational Diabetes Mellitus on the Course of Preeclampsia. J Clin Med. 2022;11(21):6390. DOI: https://doi.org/10.3390/jcm11216390
Fang Y, Liu H, Li Y, Cheng J, Wang X, Shen B, et al. A Prediction Model of Preeclampsia in Hyperglycemia Pregnancy. Diabetes Metab Syndr Obes. 2024;17:1321-33. DOI: https://doi.org/10.2147/DMSO.S453204