A global view of hypertensive disorders and diabetes mellitus during pregnancy

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. 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.

Automated summary

Hypertensive disorders in pregnancy (HDP) and gestational diabetes mellitus (GDM) are important health issues for many pregnant women worldwide, with uneven distribution in low- and middle-income countries. In addition to common clinical and behavioral risk factors, the development and consequences of maternal cardiometabolic disorders are influenced by social determinants of health. Multilevel and multisector approaches are needed to address these issues.