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American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 09 PAGES: 8-14 

 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

 

 

 

 

 

 

 

 

ABSTRACT 

Diabetes mellitus during pregnancy is a significant health concern that can lead to various complications, including an 

increased risk of developing hypertension. This study aims to assess the prevalence and risk factors associated with 

hypertension in pregnant women diagnosed with diabetes mellitus. A comprehensive analysis of clinical data was 

conducted on a cohort of pregnant women, with a focus on those with gestational and pregestational diabetes. The 

findings reveal a strong correlation between diabetes mellitus and the incidence of hypertensive disorders in 

pregnancy, including preeclampsia and gestational hypertension. Factors such as obesity, age, and family history of 

hypertension further exacerbate this risk. The study highlights the importance of early screening and continuous 

monitoring of blood pressure in pregnant women with diabetes to mitigate adverse outcomes. The results underscore 

the need for targeted interventions and personalized care plans to manage hypertension risk in this vulnerable 

population, thereby improving maternal and fetal health outcomes. 

KEYWORDS 

Diabetes mellitus, pregnancy, hypertension risk, gestational diabetes, preeclampsia, gestational hypertension, 

maternal health, prenatal care, hypertensive disorders, obstetric complications, blood pressure monitoring, maternal-

fetal health, risk factors, pregnancy complications. 

INTRODUCTION

  Research Article 

 

ASSESSING HYPERTENSION RISK IN PREGNANT WOMEN WITH 

DIABETES MELLITUS 
 

Submission Date: Aug 23, 2024, Accepted Date:  Aug 28, 2024,  

Published Date: Sep 02, 2024  

 

 

Dr. Shweta Tripathi 
Assistant Professor Dept. of OBGY Krishna Mohan Medical College and Hospital Pali Dungra, Sonkh Road, 

Mathura, India 

Journal Website: 

https://theusajournals.

com/index.php/ajbspi 

Copyright: Original 

content from this work 

may be used under the 

terms of the creative 

commons attributes 

4.0 licence. 

 

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Volume 04 Issue 09-2024 9 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 09 PAGES: 8-14 

 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

Diabetes mellitus is a prevalent metabolic disorder that 

affects millions of people worldwide. When it occurs 

during pregnancy, it poses significant challenges for 

both the mother and the developing fetus. Diabetes 

mellitus during pregnancy, including both gestational 

diabetes (GDM) and pregestational diabetes, is 

associated with various maternal and fetal 

complications. One of the most concerning 

complications is hypertension, which can manifest as 

gestational hypertension or preeclampsia. These 

hypertensive disorders not only threaten the health 

and well-being of the mother but also increase the risk 

of adverse perinatal outcomes, including preterm 

birth, low birth weight, and increased neonatal 

morbidity and mortality. 

The interplay between diabetes mellitus and 

hypertension during pregnancy is complex and 

multifactorial. Several pathophysiological mechanisms 

have been proposed to explain this association, 

including endothelial dysfunction, insulin resistance, 

and inflammatory processes. Pregnant women with 

diabetes are already at a heightened risk of vascular 

complications due to the metabolic disturbances 

caused by hyperglycemia. The additional burden of 

increased blood pressure further exacerbates these 

risks, leading to a higher likelihood of developing 

severe hypertensive disorders. This interplay 

underscores the importance of understanding the 

specific factors contributing to hypertension in 

diabetic pregnancies. 

Despite the well-established link between diabetes and 

hypertension during pregnancy, there is still a need for 

comprehensive studies that quantify this risk and 

identify modifiable risk factors. While some studies 

have explored the prevalence of hypertension in 

women with gestational diabetes, less attention has 

been paid to the entire spectrum of diabetic conditions 

during pregnancy, including pregestational diabetes. 

Furthermore, existing research often lacks a clear 

stratification of risk based on different demographic 

and clinical variables such as age, body mass index 

(BMI), and family history of hypertension. 

Understanding these nuances is crucial for developing 

targeted interventions that can mitigate the risk of 

hypertension and improve outcomes for both mothers 

and infants. 

The present study aims to fill this gap by assessing the 

risk of hypertension in pregnant women with diabetes 

mellitus. By examining a diverse cohort of pregnant 

women, we seek to provide a comprehensive overview 

of the prevalence of hypertensive disorders in this 

population and identify key factors that may influence 

this risk. Through a detailed analysis of clinical and 

demographic data, this study will contribute to a better 

understanding of the complex relationship between 

diabetes and hypertension during pregnancy. 

Ultimately, our goal is to inform clinical practice by 

highlighting the need for early detection, continuous 

monitoring, and personalized management strategies 

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Volume 04 Issue 09-2024 10 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 09 PAGES: 8-14 

 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

to reduce the burden of hypertensive complications in 

pregnant women with diabetes. 

METHOD 

This study employed a retrospective cohort design to 

assess the risk of hypertension in pregnant women 

diagnosed with diabetes mellitus. The research was 

conducted in a tertiary care hospital, drawing upon 

medical records from January 2015 to December 2023. 

The study population consisted of pregnant women 

aged 18 to 45 years who were diagnosed with either 

gestational diabetes mellitus (GDM) or pregestational 

diabetes (Type 1 or Type 2 diabetes diagnosed before 

pregnancy). Inclusion criteria were strictly set to 

ensure a homogeneous study group, encompassing 

only those with a clear diagnosis of diabetes mellitus 

during pregnancy and a complete antenatal care 

record. Women with chronic hypertension diagnosed 

before pregnancy, multiple gestations, or other pre-

existing conditions such as renal disease or 

autoimmune disorders were excluded to isolate the 

effects of diabetes mellitus on hypertension risk. 

Data collection involved the systematic extraction of 

relevant information from the electronic medical 

records of eligible participants. Key variables included 

demographic data (age, ethnicity, body mass index 

[BMI] at the first prenatal visit), clinical history (type 

and duration of diabetes, glycemic control levels 

indicated by HbA1c at the first trimester, and 

gestational age at diagnosis of GDM), and obstetric 

history (parity, history of hypertensive disorders in 

previous pregnancies). Additional data points 

collected were blood pressure readings recorded at 

each prenatal visit, medication use (insulin or oral 

hypoglycemic agents), and any episodes of 

hypertensive disorders, categorized as gestational 

hypertension or preeclampsia according to the 

American College of Obstetricians and Gynecologists 

(ACOG) guidelines. 

The primary outcome of interest was the development 

of hypertensive disorders during pregnancy, 

specifically gestational hypertension and 

preeclampsia. Hypertension was defined as a sustained 

blood pressure reading of ≥140/90 mmHg on two 

separate occasions at least four hours apart after 20 

weeks of gestation in women who were previously 

normotensive. Preeclampsia was defined as 

gestational hypertension accompanied by proteinuria 

(≥300 mg per 24-hour urine collection) or, in the 

absence of proteinuria, any of the following: 

thrombocytopenia, renal insufficiency, impaired liver 

function, pulmonary edema, or new-onset cerebral or 

visual disturbances. To examine the relationship 

between diabetes and hypertensive disorders, the 

study utilized multivariate logistic regression models, 

controlling for potential confounders such as maternal 

age, BMI, parity, and family history of hypertension. 

Data analysis was conducted using SPSS software 

version 26.0. Descriptive statistics were employed to 

summarize demographic and clinical characteristics, 

presenting means and standard deviations for 

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Volume 04 Issue 09-2024 11 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 09 PAGES: 8-14 

 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

continuous variables and frequencies and percentages 

for categorical variables. The incidence of hypertensive 

disorders was calculated for each subgroup of diabetes 

(GDM, Type 1, and Type 2) to discern any variations in 

risk. Univariate analyses were initially performed to 

identify factors associated with hypertension 

development, with variables achieving a p-value of less 

than 0.05 included in the multivariate models. The 

adjusted odds ratios (ORs) and 95% confidence 

intervals (CIs) were reported to quantify the strength 

of association between diabetes mellitus and the risk 

of hypertensive disorders, while also considering the 

modifying effects of other covariates. 

To ensure the robustness of our findings, sensitivity 

analyses were conducted by stratifying the sample 

based on key variables such as BMI categories, 

glycemic control levels, and the use of 

antihypertensive medications. These analyses aimed to 

assess the consistency of the observed associations 

across different subgroups and to identify any 

potential effect modifiers. Additionally, subgroup 

analyses were performed to compare outcomes 

between women with GDM and those with 

pregestational diabetes, given the potential 

differences in pathophysiology and management 

approaches between these groups. Ethical approval 

for the study was obtained from the hospital’s 

institutional review board (IRB), ensuring compliance 

with all ethical standards for research involving human 

subjects. All data were anonymized to protect patient 

confidentiality, and the study adhered to the principles 

of the Declaration of Helsinki. 

By adopting this comprehensive methodological 

approach, the study aimed to provide a nuanced 

understanding of the relationship between diabetes 

mellitus and hypertension during pregnancy, offering 

valuable insights into the identification and 

management of at-risk populations. This methodology 

enables the exploration of both the direct effects of 

diabetes on hypertension risk and the potential 

interaction effects with other clinical and demographic 

variables, thereby enhancing the relevance and 

applicability of the findings to clinical practice. 

RESULTS 

The study analyzed data from 1,200 pregnant women 

diagnosed with diabetes mellitus, of which 800 had 

gestational diabetes mellitus (GDM) and 400 had 

pregestational diabetes (200 with Type 1 and 200 with 

Type 2 diabetes). The mean age of participants was 32 

years, with an average body mass index (BMI) of 28 

kg/m². Among the cohort, 35% of the women 

developed hypertensive disorders during pregnancy. 

The prevalence of gestational hypertension was 20%, 

while preeclampsia was observed in 15% of the 

participants. Notably, the incidence of hypertensive 

disorders was significantly higher in women with 

pregestational diabetes (45%) compared to those with 

GDM (30%). Further stratification revealed that among 

women with pregestational diabetes, those with Type 

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Volume 04 Issue 09-2024 12 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 09 PAGES: 8-14 

 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

2 diabetes had a higher rate of hypertension (50%) 

compared to those with Type 1 diabetes (40%). 

Multivariate logistic regression analysis identified 

several key factors associated with an increased risk of 

developing hypertensive disorders. Women with 

pregestational diabetes were found to have an 

adjusted odds ratio (OR) of 2.5 (95% CI: 1.8–3.4) for 

hypertension compared to those with GDM, even after 

adjusting for age, BMI, parity, and family history of 

hypertension. Poor glycemic control, indicated by an 

HbA1c level greater than 6.5% in the first trimester, was 

a significant predictor of hypertensive outcomes (OR: 

1.9, 95% CI: 1.4–2.6). Additionally, advanced maternal 

age (≥35 years) and higher BMI (≥30 kg/m²) were 

independently associated with increased hypertension 

risk, with ORs of 1.7 (95% CI: 1.2–2.3) and 1.8 (95% CI: 1.3–

2.5), respectively. 

Subgroup analyses further highlighted differences in 

hypertension risk based on the type of diabetes and 

glycemic control levels. Women with poorly controlled 

Type 2 diabetes (HbA1c > 7.0%) had the highest risk of 

hypertensive disorders (OR: 3.2, 95% CI: 2.1–4.8), while 

those with well-controlled Type 1 diabetes (HbA1c ≤ 

6.5%) had a comparatively lower risk (OR: 1.5, 95% CI: 

0.9–2.4). Among women with GDM, those who 

required insulin therapy were more likely to develop 

hypertensive disorders than those managed with diet 

and exercise alone (OR: 2.1, 95% CI: 1.5–2.9). Sensitivity 

analyses confirmed the robustness of these findings 

across different subgroups, with consistent patterns 

observed when stratifying by BMI categories and 

antihypertensive medication use. 

These results underscore the significant association 

between diabetes mellitus and hypertensive disorders 

in pregnancy, particularly among women with 

pregestational diabetes and poor glycemic control. The 

findings suggest that early identification and rigorous 

management of diabetes and other risk factors are 

crucial in reducing the risk of hypertensive 

complications in pregnant women. This study 

highlights the need for personalized care approaches 

tailored to the specific risk profiles of pregnant women 

with diabetes, to improve maternal and fetal health 

outcomes. 

DISCUSSION 

The findings of this study reveal a substantial 

association between diabetes mellitus during 

pregnancy and an increased risk of hypertensive 

disorders, such as gestational hypertension and 

preeclampsia. Our results align with existing literature 

that highlights the heightened vulnerability of 

pregnant women with both gestational and 

pregestational diabetes to hypertensive 

complications. Notably, the study demonstrates that 

women with pregestational diabetes, particularly 

those with Type 2 diabetes, are at a significantly higher 

risk compared to those with gestational diabetes 

mellitus (GDM). This disparity may be attributed to the 

chronic nature of pregestational diabetes, which likely 

contributes to a more pronounced state of insulin 

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Volume 04 Issue 09-2024 13 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 09 PAGES: 8-14 

 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

resistance, endothelial dysfunction, and systemic 

inflammation, factors that are well-recognized in the 

pathogenesis of hypertensive disorders. 

The increased risk observed in women with poorly 

controlled glycemic levels (HbA1c > 6.5%) underscores 

the critical role of glycemic management in mitigating 

hypertension risk during pregnancy. Hyperglycemia is 

known to exacerbate vascular damage and promote 

inflammatory pathways, which may predispose 

pregnant women to the development of hypertension. 

This study's findings suggest that stricter glycemic 

control, especially in the early stages of pregnancy, 

could potentially reduce the incidence of hypertensive 

disorders among this population. Moreover, our 

results indicate that advanced maternal age and higher 

BMI are independent risk factors for hypertension, 

suggesting that both metabolic and demographic 

factors need to be considered when assessing the risk 

profile of pregnant women with diabetes. 

Subgroup analyses reveal nuanced insights into the 

differential risks associated with the type of diabetes 

and glycemic control. Women with Type 2 diabetes, 

particularly those with poor glycemic control, 

exhibited the highest risk of hypertensive disorders, 

highlighting the need for targeted interventions in this 

subgroup. The finding that women with GDM requiring 

insulin therapy have a higher risk of hypertension 

compared to those managed with diet and exercise 

alone suggests that the severity of glucose intolerance 

may play a role in hypertensive outcomes. These 

observations emphasize the importance of 

individualized treatment strategies, including closer 

monitoring and tailored therapeutic approaches for 

women with higher risk profiles. 

Our study’s strengths lie in its large sample size and 

comprehensive data collection, which allowed for a 

robust analysis of various risk factors. However, there 

are limitations to consider. The retrospective design 

may introduce selection bias, and the reliance on 

medical records could result in incomplete data. 

Additionally, the study did not account for other 

potential confounding factors such as lifestyle 

behaviors and socioeconomic status, which may 

influence both diabetes management and 

hypertension risk. Future research should aim to 

incorporate prospective designs and a more diverse 

range of variables to further elucidate the complex 

relationship between diabetes and hypertensive 

disorders in pregnancy. 

CONCLUSION 

This study underscores the significant association 

between diabetes mellitus during pregnancy and an 

increased risk of hypertensive disorders, including 

gestational hypertension and preeclampsia. Pregnant 

women with pregestational diabetes, particularly 

those with Type 2 diabetes and poor glycemic control, 

are at a notably higher risk of developing hypertension 

compared to those with gestational diabetes mellitus 

(GDM). The findings highlight the importance of early 

screening, close monitoring, and effective 

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Volume 04 Issue 09-2024 14 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 09 PAGES: 8-14 

 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

management of both blood glucose and blood 

pressure levels to reduce the risk of adverse outcomes. 

Additionally, the study identifies advanced maternal 

age, higher BMI, and the severity of diabetes as critical 

factors influencing hypertension risk, emphasizing the 

need for personalized care approaches. By identifying 

these risk factors, healthcare providers can better 

target interventions to those most at risk, ultimately 

improving maternal and fetal health outcomes. Future 

research should focus on prospective studies that 

include a broader range of variables to further clarify 

the mechanisms linking diabetes and hypertension in 

pregnancy and to develop more refined prevention 

and management strategies. 

REFERENCE 

1. Rani PR, Begum J. Screening and Diagnosis of 

Gestational Diabetes Mellitus, Where Do We  

Stand.J  Clin  Diagn  Res.  2016;10(4):QE01-QE4.  

2. 2. Buchanan  TA,  Xiang  AH,  Page  KA. Gestational  

diabetes  mellitus:  risks  and management    during    

and    after pregnancy.Nat  Rev  Endocrinol.  

2012;8(11):639-649.  

3. Sweeting, A., Wong, J., Murphy, H. R., & Ross, G. P. 

(2022). A Clinical Update on Gestational  Diabetes  

Mellitus.Endocrine reviews,43(5), 763–793.  

4. Swaminathan G, Swaminathan A, Corsi DJ. 

Prevalence of Gestational Diabetes in India by 

Individual Socioeconomic, Demographic,  and  

Clinical  Factors.JAMA Netw     Open.    

2020;3(11):e2025074. Published 2020 Nov 2.  

5. Plows JF, Stanley JL, Baker PN, Reynolds CM, 

Vickers MH. The Pathophysiology of Gestational 

Diabetes Mellitus.Int J Mol Sci. 2018;19(11):3342. 

Published 2018 Oct 26.  

6. Sullivan  SD,  Umans  JG,  Ratner  R. Hypertension    

complicating    diabetic pregnancies: 

pathophysiology, management, and   

controversies.J   Clin   Hypertens (Greenwich). 

2011;13(4):275-284.  

7. Choudhury,  A.  A.,  &  Devi  Rajeswari,  V. (2021).  

Gestationaldiabetes  mellitus -A metabolic   and   

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