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Screening of Gestational Diabetes 

and Hypertension Among 

Antenatal Women in Rural West 

India 
 

 

Viral R. Dave1, Bhavik M. Rana1, 

Kantibhai N. Sonaliya1, Suraj J. 

Chandwani2, Samkit V. Sharma2, 

Swati O. Khatri2, Khalid M. 

Shaikh2, Farida M. Hathiari2 

 

1Community Medicine Department, 
Gujarat Cancer Society (GCS) Medical 
College, Ahmedabad, Gujarat, India; 
2Gujarat Cancer Society (GCS) Medical 
College Hospital & Research Centre, 
Ahmedabad, Gujarat, India 

 

 

 

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Abstract 

Background: Hypertension and gestational diabetes are among the leading causes of maternal and perinatal mortality, especially 

in rural areas of developing countries with meager health facilities. With early diagnosis and timely treatment, these adverse events 

can be decreased. The primary aim of this study was to implement a screening program for gestational diabetes and hypertension, 

and to assess risk factors associated with these conditions among antenatal women in the rural area of the Gujarat province in India. 

Methods: A cross–sectional study was conducted at one of the rural areas of Gujarat province in India. Following a random  cluster 

sampling procedure, the village of Davas was selected. A multistage random sampling method was utilized, resulting in a sample 

of 346 antenatal women. Screening guidelines from the American Diabetes Association were followed for gestational diabetes 

screening.  

Results: The majority of antenatal mothers (55.50%) were between 21-25 years of age. 242 antenatal women were multigravida, 

and among them, 85.96% had institutional delivery at their last pregnancy. Of the total 346 women, 17.60% were prehypertensive. 

The prevalence of systolic hypertension was 1.40%, diastolic hypertension was 0.90%, and gestational diabetes was 1.73%.  

Conclusion: Socioeconomically upper class, a family history of hypertension, and BMI ≥ 25 were strong risk factors for 

hypertension during pregnancy and gestational diabetes. Health education should be made readily available to antenatal mothers 

by paramedical workers regarding symptoms of hypertension and gestational diabetes mellitus for early self identification. 

Keywords: gestational diabetes, hypertension, screening, maternal mortality, perinatal mortality 

 

Screening of Gestational Diabetes 

and Hypertension Among Antenatal 

Women in Rural West India 

 

Viral R. Dave1, Bhavik M. Rana1, 

Kantibhai N. Sonaliya1, Suraj J. 

Chandwani2, Samkit V. Sharma2, 

Swati O. Khatri2, Khalid M. Shaikh2, 

Farida M. Hathiari2 

 

1Community Medicine Department, Gujarat 
Cancer Society (GCS) Medical College, 
Ahmedabad, Gujarat, India; 2Gujarat Cancer 
Society (GCS) Medical College Hospital & 
Research Centre, Ahmedabad, Gujarat, 
India 

Research 

Maternal mortality and perinatal mortality are 

two very important indicators of the developmental index 

of a country and have a significant impact on the 

population’s life expectancy. Hypertension (HTN) 

during pregnancy/pre-eclampsia and gestational diabetes 

are among the leading causes of maternal and perinatal 

morbidity and mortality, especially in rural areas of 

developing countries.1,2 

The literature suggests that 10-15% of maternal 

mortality in developing countries is due to hypertensive 

disorders of pregnancy.3,4 Various adverse effects of 

HTN in pregnancy include preterm delivery, intrauterine 

growth retardation, reduced birth weight, still birth, and 

perinatal mortality.5,6 Early detection and prompt care are 

required to prevent adverse outcomes of pregnancy with 

HTN. For this reason, it is recommended to evaluate a 

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woman’s risk for HTN at their first prenatal visit. In 

India, the National Health Programme of Reproductive 

and Child Health has stipulated routine screening of 

blood pressure (BP) for antenatal mothers at each visit, 

which should be implemented in conjunction with the 

assessment of maternal history of HTN symptoms. 

Prevalence of gestational diabetes mellitus 

(GDM) in some ethnic groups ranges from 1 to 14% 

depending on screening method selection, diagnostic 

criteria, and population screened. GDM can negatively 

affect pregnancy and result in adverse perinatal outcomes 

such as macrosomia, birth trauma, shoulder dystocia, and 

higher rates of Cesarean section.7 In India, screening is 

essential in all pregnant women, as Indian women have 

an eleven-fold increased risk8 of developing glucose 

intolerance during pregnancy compared to Caucasian 

women,9 which can be decreased with early screening, 

diagnosis, and treatment. It is generally accepted that 

women of Asian origin, especially ethnic Indians, are at 

a higher risk of developing GDM and subsequently type 

2 diabetes.10,11 The so-called Asian-Indian phenotype 

refers to certain unique clinical and biochemical 

abnormalities in Indians, which includes, but is not 

limited to, increased insulin resistance and greater 

abdominal adiposity. This phenotype makes Indians 

more prone to diabetes.12 

The objective of this study was to implement 

screening for gestational diabetes and HTN and to 

investigate risk factors associated with the development 

of these conditions among women in Gujarat province in 

India. The ultimate goal of this work was to minimize 

complications and reduce morbidity and mortality 

associated with gestational diabetes and HTN in high-

risk groups.  

 

Methodology 

After obtaining permission from the 

Institutional Ethical Committee at Gujarat Cancer 

Society (GCS) Medical College, Hospital & Research 

Centre, Ahmedabad, India, the present study was 

conducted at one of the rural areas of the Gujarat 

province in India.  The study was conducted between 

March 2013 and June 2013 and utilized cross-sectional 

assessments. A multistage random cluster sampling 

method was utilized to obtain a sample of 346 antenatal 

women. After preparing a list of districts of Gujarat state 

in their ascending order as per their population, the 

Banaskantha district was randomly selected. Following 

random selection procedure, the taluka “Deesa” 

(administrative subunit of district) and the village of 

“Davas” were selected. 

The Primary Health Centre (PHC) is a very 

basic medical setting, which provides health care services 

to rural populations. The PHC of Davas was contacted to 

ascertain a list of “anganwadi” discovered in the field 

practice area of PHC. Anganwadi is a part of the Indian 

public health-care system where basic health-care 

activities are carried out for antenatal and postnatal 

women, adolescent girls, and children less than 6 years 

of age. PHC in Davas covers a total population of 39,001 

people and 15 other villages around Davas, as per the 

2011 census. Anganwadi centers are a basic unit of the 

Integrated Child Development Scheme run by the 

government of India and provide health care services to 

antenatal and postnatal women, adolescent girls, and 

children less than 6 years of age. Monthly prenatal check 

ups is one of the key health services provided by these 

centers. A total of 346 antenatal women were registered 

with all anganwadis covered by Davas PHC. All were 

interviewed and after informed consent was taken from 

each participant, they were included in the study. A 

pretested and structured questionnaire on socio-

demographic information, obstetric details, and outcome 

of screening tests was used for data collection. Various 

risk factors generally associated with gestational diabetes 

and HTN such as age, BMI (body mass index), education, 

occupation, socioeconomic class, and family history 

were also assessed using questionnaires. 

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The modified Prasad classification13 was used 

for socioeconomic stratification, which is commonly 

used on the Indian subcontinent. This classification 

system divides the community into five different classes 

based on per capita income of family and taking into 

consideration All India Consumer Price Index declared 

by the Labour Bureau, Government of India at the time 

of study.14 

For screening of gestational diabetes, guidelines 

of American Diabetes Association15 were followed, 

which state that: a fasting plasma glucose level > 126 

mg/dl (7.0 mmol/l) or casual plasma glucose > 200 mg/dl 

(11.1 mmol/l) meets the threshold for diagnosis of 

diabetes, if confirmed on a subsequent day and precludes 

need for any glucose challenge. Following the above-

mentioned guidelines, random blood sugar levels (RBS) 

were measured using a standard glucometer (Glucosign 

@ Accubiotech).  Participants with RBS > 200 mg/day 

were re-screened on the following day with a fasting 

blood sugar. 

Blood pressure was classified per the following 

criteria:16 normal if < 120 systolic BP and < 80 diastolic 

BP, prehypertension if 120-139 systolic BP or 80-89 

diastolic BP, Stage I HTN if 140-159 systolic BP or 90-

99 diastolic BP, and Stage II HTN if systolic BP ≥ 160 or 

diastolic BP  ≥ 100. A standard sphygmomanometer was 

used to measure BP. All BP measurements were taken in 

sitting position, and on finding BP higher than normal, a 

recording was repeated immediately and also on the next 

day to ensure that measurements were accurate. 

Conservative recording of the lowest reading was 

evaluated in the data analysis. Data entry and data 

analysis were performed using SPSS software. Risk 

factors for HTN and diabetes were analysed by bi-variate 

analysis along with the use of odds ratios. 

 

Results 

Table 1 presents sociodemographic data of 

study participants at baseline. The majority of antenatal 

mothers (55.50%) were 21-25 years of age. It is 

noteworthy that 21.10% of pregnant women were ≤ 20 

years of age while 2.89% of participants were > 30 years 

aged. 60.98% of expectant mothers were illiterate, and 

only 0.87% had education at secondary school level, 

while none of them had completed any secondary 

education. Most of participant females were housewives 

(63.58%), while 34.97% of mothers were engaged in 

strenuous labor activities such as farming, construction, 

etc. Based on modified Prasad classification for 

socioeconomic class, the majority of women belonged to 

lower socioeconomic classes. 39.60% of women were 

from class IV and 42.77% belonged to socioeconomic 

class V. 7.23% of antenatal women had a BMI ≥ 25. 

 

Table 1: Baseline characteristics of study participants 

 

Table 2 describes obstetric profiles of study 

participants. 69.94% of antenatal women were 

multigravida, while 30.06% were primigravida. In 

multigravida participants, most deliveries were 

institutional (85.96%) while 14.04% of mothers had their 

last delivery without medical supervision. Of this 14.04% 

of mothers, the majority had home delivery; however, 

some delivered at their work place, including farms. 

11.57% had their deliveries conducted by traditional birth 

attendants (TBA) known as “dai” in India, while 2.47% 

of deliveries were conducted by other attendants 

(including relatives, neighbors, and quacks). 

 

Table 2: Obstetric profile of study participants 

 

Figure 1 shows the distribution of BP among 

antenatal women in the study at screening. It suggests 

that 80.90% of study participants had systolic BP within 

normal range, while 17.60% were prehypertensive. 

1.20% and 0.20% had stage I and stage II systolic BP 

HTN, respectively. Diastolic BP distribution was 

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somewhat different. 90.80% had normal diastolic BP. 

8.40% were prehypertensive, while 0.60% and 0.30% 

had stage I and II diastolic BP HTN, respectively. 

 

Figure 1: Distribution of stages of hypertension among 

antenatal women at screening 

 

Table 3 suggests the role of various risk factors 

associated with HTN, using odds ratio based on bi-

variate analysis. The risk factors evaluated were age, 

BMI ≥ 25, lower socioeconomic class, occupation, 

education and family history positive for HTN. Upper 

socioeconomic class and positive family history of HTN 

were significantly (p < 0.05) associated with HTN among 

study participants. 

 

Table 3: Odds ratio for risk factors found to be associated 

with systolic hypertention 

 

Random blood sugar levels were checked for 

screening of GDM as per guidelines mentioned in 

methodology. The screening yielded 1.73% antenatal 

mothers had their RBS levels more than 200 mg/dl on 

two occasions. None of them were known cases of 

diabetes, while 98.27% had their RBS within normal 

range.  

The role of various risk factors associated with 

gestational diabetes, using odds ratio based on bi-variate 

analysis is described in Table 4. It shows that among 

various risk factors such as age, BMI ≥ 25, upper 

socioeconomic class, occupation, education, and family 

history of HTN, only a BMI of ≥ 25 was significantly (p 

< 0.05) associated with GDM among study participants. 

 

Table 4: Odds ratio for risk factors found to be associated 

with gestational diabetes 

Discussion 

The present study found the prevalence of 

systolic HTN was 1.40%, diastolic HTN was 0.90%, and 

GDM was 1.73%. Upper socioeconomic class and 

positive family history of HTN were significantly 

associated with HTN. While analyzing other risk factors, 

only BMI ≥ 25 was significantly associated with GDM 

among study participants.  

A study conducted by Yadav et al.17 found a 

prevalence of HTN as high as 8.70% among females of 

less than 40 years of age. However, the sample included 

females from an urban colony of high-income residents 

among the general population, which could be 

responsible for the high prevalence. While the 

government is expending a considerable amount of funds 

as well as manpower to decrease maternal and perinatal 

mortality, it appears that residents of remote rural and 

tribal areas may not be taking advantage of some of the 

screening and early diagnosis practices.  

The overall prevalence of diabetes in the 

western region of India was found to be 3.70%;18 

however, in this study, all age groups as well as all 

genders were included in this study. A previous study19 

conducted in Punjab region of India showed a prevalence 

of systolic HTN at 4.45% and diastolic HTN at 4.20% in 

a sample of 1,000 pregnant females, while the present 

study found a prevalence of systolic HTN was only 

1.40% and diastolic HTN was 0.90%. The differences 

between this study and the above mentioned study could 

be attributed to a larger sample size from both rural and 

urban areas of the Punjab state used in the previous study. 

Sayeed et al.20 found in their study at 

Bangladesh a crude prevalence of systolic and diastolic 

HTN was 6.80% and 5.40%, respectively, possibly due 

to the inclusion of a higher aged sample. Bener and 

Saleh21 in their study at Qatar found maternal age > 30, 

increased BMI, previous abortion, lack of antenatal care, 

and physical activity were significantly associated with 

an increased risk of Pregnacy Induced Hypertension 

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(PIH). In the current study, upper socioeconomic class 

and positive family history of HTN were found to be 

associated with HTN, which is comparable to other 

similar studies.20,21 

In the present study, the prevalence of GDM 

was found to be 1.73%. Kalra et al.22 found a prevalence 

of GDM among the study population was 6.60%, while 

Gupta et.al.23 in the Jammu region of India found a 

prevalence of GDM was 3.05%. These data reveal a wide 

variation in the prevalence of gestational diabetes in 

India. A previous study24 conducted in Haryana, North 

India, showed 7.10% prevalence, while another study25 

conducted in South India revealed prevalence of 17.80% 

women in urban, 13.80% in semi urban, and 9.90% in 

rural population of gestational diabetes. Sayeed et al.20 in 

Bangladesh found the prevalence of diabetes was 6.80% 

according to fasting blood glucose (FBG) guideline 

values. In the present study, we found that only BMI ≥ 

25 was significantly associated with GDM, while 

Sheshiah et al.25 found that age ≥ 25 years, BMI ≥ 25 

kg/m2, and positive family history of diabetes were 

significantly associated with GDM. Rajput et al.24 found 

that socioeconomic status above upper middle class and 

Kalra et al.22 found that family history of diabetes 

mellitus, age ≥ 25 years, past history of GDM, and BMI 

≥ 25 kg/m2 were significantly associated with GDM 

group.  Rajput et al.24 found that socioeconomic status 

above upper middle class was associated significantly 

with GDM in their findings. Kalra et al.22 found that a 

family history of diabetes mellitus, age ≥ 25 years, past 

history of GDM, and BMI ≥ 25 kg/m2 were significantly 

associated with GDM group in their study.  

55.49% of participants in the present study were 

21-25 years of age, and 60.98% were illiterate. In a 

similar study by Rajput et al.24 58.20% were 21-25 years 

of age, while only 4.90% were illiterate. Literacy rate in 

the present study was low as compared to national 

average (65.46%) and Gujarat state average (70.73%) for 

females.26 The reason may be due to the fact that the 

selected district was in a remote area with tribal vicinity. 

In the same study, Rajput et al.24 found that 8.20% of 

participants had a BMI ≥ 25 while in current study it was 

7.20%. 

 

Limitations of the Study 

This investigation had one main limitation. Though 

most research recommends Oral Glucose Tolerance Test 

(OGTT) as a method of choice for screening of diabetes, 

this method was not possible to implement in the context 

in this study. OGTT is supposed to be performed under 

clinical observation with laboratory set up. It also 

requires multiple blood draws for which the subject needs 

to be contacted more than 2 times and requires longer 

time duration (3-4 hours).  As the current study is a cross 

sectional study with limited resources at remote rural 

area, the necessary time, human resource and financial 

resources were limiting factors for conducting GTT.  

 

Strengths of the Study  

As there are very limited number of studies 

conducted in the past involving pregnant women of rural 

India, this study can contribute significantly and provide 

a glimpse about health conditions of antenatal women in 

rural population of India. The current study also provided 

an opportunity to contact study subjects and identify 

some previously undetected at risk women who were 

referred for further evaluation and management.  

 

Conclusion & Recommendations 

The present study found prevalence of systolic 

HTN was 1.40%, diastolic HTN was 0.90%, and GDM 

was 1.73% among study population in the rural area of 

Gujarat province, India. Overall, the prevalence of 

gestational diabetes and HTN in the Gujarat state should 

be evaluated in the future with a multicenter study and 

larger sample size. Incidence and prevalence rate of any 

specific disease is the basis for making prevention 

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strategies at national level of health planning. A proper 

disease registry should be created for monitoring 

gestational diabetes and pregnancy induced HTN. Public 

health education should be made readily available to 

antenatal mothers by paramedical workers regarding 

alarming symptoms of HTN and GDM for early self 

identification. Adopting a healthy life style and 

monitoring blood pessure and sugar levels are keys for 

prevention of HTN and diabetes in India and globally.  

 

Conflict of Interest 

The authors report no conflict of interest.  

 

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http://censusindia.gov.in/2011-prov-results/data_files/india/Final_PPT_2011_chapter6.pdf
http://censusindia.gov.in/2011-prov-results/data_files/india/Final_PPT_2011_chapter6.pdf


 

 

CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 

 

 

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This journal is published by theUniversity Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 3, No. 1 (2014) |  ISSN 2166-7403 (online)  | DOI 10.5195/cajgh.2014.140|http://cajgh.pitt.edu 

 

 

Table 1: Baseline characteristics of study participants from the Davas village 

Characteristics Number of Participants (%) 

Age (years)  

     ≤ 20 73 (21.10) 

     21 – 25 192 (55.49) 

     26 – 30 71 (20.52) 

     31 – 35  9 (2.60) 

     ≥ 36 1 (0.29) 

Education  

     Illiterate 211 (60.98) 

     Primary 132 (38.15) 

     Secondary and above 3 (0.87) 

Occupation  

     Housewife 220 (63.58) 

     Laborer 121 (34.97) 

     Other 5 (1.45) 

Socioeconomic class  

      I 3 (0.87) 

     II 18 (5.20) 

    III 40 (11.56) 

    IV 137 (39.60) 

    V 148 (42.77) 

BMI (Kg/M2)  

     < 18.5 68 (19.65) 

     18.5 – 25  253 (73.12) 

     ≥ 25 25 (7.23) 

 

  

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DAVE 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 

This journal is published by theUniversity Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 3, No. 1 (2014) |  ISSN 2166-7403 (online)  | DOI 10.5195/cajgh.2014.140|http://cajgh.pitt.edu 

 

 

Table 2: Obstetric profile of study participants 

Characteristics Number of Participants (%) 

Gravida  

Primigravida 104 (30.06) 

     Multigravida 242 (69.94) 

Last delivery conducted (n = 242)  

     Institutional deliveries 208 (85.96) 

Traditional birth attendants 28 (11.57) 

Other 6 (2.47) 

Mode of last delivery (n = 242)  

     Full term normal delivery 202 (83.47) 

     Premature delivery 7 (2.89) 

     Miscarriage 2 (0.83) 

     Abortion 27 (11.16) 

     Cesarian section 4 (1.65) 

 

  

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CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 

 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 

This journal is published by theUniversity Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 3, No. 1 (2014) |  ISSN 2166-7403 (online)  | DOI 10.5195/cajgh.2014.140|http://cajgh.pitt.edu 

 

 

Table 3: Odds ratio for risk factors found to be associated with systolic hypertension 

Risk factors Odds ratio 

95% Confidence interval 

p-value Lower Upper 

Age > 25 years 0.81 0.08 7.37 0.60 

BMI ≥ 25 3.29 0.35 30.62 1.25 

SE Upper Class (I + II)* 7.77 1.27 47.60 0.03 

Housewife 0.14 0.01 1.26 0.13 

Education (Illiterate) 0.15 0.01 1.41 0.08 

Family history* 2.89 0.32 25.83 0.02 

Note. * denotes significance with a p < 0.05. 

  

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DAVE 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 

This journal is published by theUniversity Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 3, No. 1 (2014) |  ISSN 2166-7403 (online)  | DOI 10.5195/cajgh.2014.140|http://cajgh.pitt.edu 

 

 

Table 4: Odds ratio for risk factors found to be associated with gestational diabetes 

Risk factors Odds ratio 

95% Confidence interval 

p-value Lower Upper 

Age > 25 years 1.66 0.30 9.26 0.38 

BMI ≥ 25* 5.36 0.53 53.94 0.01 

SE Upper Class (I + II) 1.53 0.73 3.21 0.46 

Housewife 1.14 0.20 6.35 0.28 

Education (Illiterate) 1.29 0.23 7.14 0.81 

Family history 1.78 0.27 8.13 0.09 

Note. * denotes significance with a p < 0.05.  

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CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 

 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 

This journal is published by theUniversity Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 3, No. 1 (2014) |  ISSN 2166-7403 (online)  | DOI 10.5195/cajgh.2014.140|http://cajgh.pitt.edu 

 

 

Figure 1: Distribution of stages of hypertension among antenatal women at screening 

 

 

 

 

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