European Journal of Cardiovascular Medicine

Non-communicable diseases (NCDs) are increasingly contributing to maternal and fetal morbidity and mortality worldwide. Pregnancy imposes substantial physiological changes in cardiovascular, metabolic, and endocrine systems; when conditions such as hypertension, gestational diabetes mellitus (GDM), obesity, or thyroid disorders coexist, the risk of adverse outcomes rises sharply [1,2]. Understanding the prevalence and impact of these NCDs during pregnancy is especially important in low- and middle-income settings such as India, where healthcare access, nutritional status, and sociodemographic factors vary widely.

Hypertensive disorders of pregnancy (HDP), including gestational hypertension, preeclampsia, eclampsia, and chronic hypertension, are among the leading causes of maternal mortality and perinatal morbidity. A meta-analysis of Indian studies found the pooled prevalence of HDP to be about 9% in sensitivity analyses, with gestational hypertension, preeclampsia-eclampsia and chronic hypertension contributing variably [3]. In a prospective hospital-based study in Northeast India including 5,460 deliveries, 402 (7.4%) had HDP; among these, 27.6% had gestational hypertension, 27.6% mild preeclampsia, 33.6% severe preeclampsia, and 11.2% eclampsia. Maternal mortality in that cohort was 2.9% among HDP cases, and perinatal mortality was significantly elevated among severe and early-onset disease [1]. Early-onset HDP has been shown to carry a much higher risk of perinatal death compared to late-onset HDP, with low birth weight and preterm birth more frequent [7].

Gestational diabetes mellitus is a state of glucose intolerance first recognized during pregnancy, and is associated with higher rates of maternal and neonatal complications. A population-based cohort in South Delhi reported a GDM prevalence of 19.2% among pregnant women who had at least one oral glucose tolerance test. Risk factors included older maternal age, higher body mass index (BMI), and prediabetes at pregnancy confirmation. GDM in that study was also associated with adverse outcomes including preterm birth, stillbirth, large for gestational age babies, and increased need for cesarean section [2]. Other national-level surveys show variability across Indian regions, with prevalence ranging from 1% to over 20% depending on methodology and population studied [4].

Maternal obesity, defined by elevated pre-pregnancy BMI, is another significant risk factor that acts synergistically with hypertension and GDM. In an Indian study, over 25% of pregnant women were overweight or obese. In that cohort, gestational diabetes was observed among 19.1% of overweight or obese cases; preeclampsia occurred in 35.9%; and the cesarean section rate was markedly elevated [5]. Another multinational cohort study found that overweight and obesity were strongly associated with higher risk of GDM, HDP, preterm delivery, increased cesarean section rates, large for gestational age, and stillbirth [6].

Thyroid dysfunction, both overt and subclinical, is another important contributor to maternal and perinatal complications. Hypothyroidism during pregnancy has been associated with miscarriage, preeclampsia, anemia, placental abruption, and impaired neurodevelopment of the fetus [8]. Indian studies have reported a prevalence of thyroid dysfunction ranging from 11% to 17% among pregnant women, with subclinical hypothyroidism being the most common [9]. Women with thyroid dysfunction are at higher risk of preterm birth, low birth weight, intrauterine growth restriction, and neonatal intensive care admission compared to euthyroid women [10].

While individual studies have examined hypertension, GDM, obesity, and thyroid disorders, relatively few hospital-based studies in Northern India have assessed multiple NCDs in pregnancy together and correlated them with both maternal and fetal outcomes. Given that hypertension and GDM often co-exist in obese or overweight mothers, and that early detection and management can alter outcome trajectories, a cross-sectional hospital-based study in Government Medical College Kathua, including 100 pregnant women will help fill this gap. The study aims to estimate the prevalence of NCDs in pregnancy, classify their types, and evaluate maternal and fetal complications in this region.

Study Design and Setting

This was a hospital-based cross-sectional study conducted in the Department of Obstetrics and Gynecology, Government Medical College Kathua, over a one year period from September  2023 to August  2024. The institution serves as a referral center for the district and adjoining rural areas, catering to both low-risk and high-risk pregnancies.

Study Population

The study included 100 pregnant women admitted for antenatal care or delivery during the study period who were diagnosed with at least one non-communicable disease (hypertensive disorder of pregnancy, gestational diabetes mellitus, obesity, or thyroid dysfunction).

Inclusion Criteria

• Pregnant women of any parity aged 18–40 years.
• Diagnosis of any one of the following NCDs during the index pregnancy:

 *Hypertensive disorders of pregnancy (gestational hypertension, preeclampsia, eclampsia, or chronic hypertension).

   * Gestational diabetes mellitus (as per WHO 2013 criteria: fasting plasma glucose ≥92 mg/dl, 1-hour ≥180 mg/dl, 2-hour ≥153 mg/dl after 75 g oral glucose tolerance test).

   * Obesity (pre-pregnancy BMI ≥25 kg/m² as per WHO Asian cut-offs).

   * Thyroid dysfunction (defined by trimester-specific TSH cut-off values and free T4 levels).

Exclusion Criteria

1. Multiple pregnancies.
2. Pregnant women with pre-existing type 1 or type 2 diabetes mellitus diagnosed before conception.
3. Women with chronic systemic illnesses such as chronic kidney disease, autoimmune disorders, or cardiac disease unrelated to pregnancy.

Data Collection

Data were collected using a structured proforma designed for the study. Detailed maternal history including age, parity, residence, socioeconomic status, family history of diabetes or hypertension, and obstetric history were recorded. Clinical examination included blood pressure measurement, body mass index calculation, and obstetric assessment.

Laboratory investigations included complete blood counts, liver and renal function tests, thyroid function tests, fasting and postprandial blood sugars, and oral glucose tolerance tests where indicated. Ultrasonography was used for gestational age confirmation, fetal growth monitoring, and detection of complications such as intrauterine growth restriction or oligohydramnios.

Outcome Measures

Maternal outcomes studied included incidence of preeclampsia, eclampsia, HELLP syndrome, cesarean section, postpartum hemorrhage, and maternal mortality. Fetal outcomes included preterm birth, intrauterine growth restriction, low birth weight, neonatal intensive care unit (NICU) admission, stillbirth, and perinatal mortality.

Statistical Analysis

Data were compiled in Microsoft Excel and analyzed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were expressed as frequencies, percentages, means, and standard deviations. Association between categorical variables was tested using Chi-square or Fisher’s exact test. A p-value of <0.05 was considered statistically significant.

A total of 100 pregnant women with non-communicable diseases were included in this hospital-based cross-sectional study. The demographic profile, distribution of NCDs, maternal complications, fetal outcomes, and mode of delivery are presented below.

Most women were between 21–30 years of age (58%), and the majority belonged to rural areas (64%). Multiparous women constituted 56% of the study group [Table 1].

Table 1. Demographic Characteristics of the Study Population

Hypertensive disorders were the most frequent NCD (40%), followed by gestational diabetes (30%), thyroid dysfunction (20%), and obesity (10%) [Table 2].

Table 2. Distribution of Non-Communicable Diseases in Study Population

Hypertensive disorders were strongly associated with preeclampsia and eclampsia, while GDM contributed to increased cesarean sections.

Table 3. Maternal Complications Observed

Adverse fetal outcomes were more frequent in hypertensive pregnancies, particularly IUGR, preterm birth, and NICU admission.

Table 4. Fetal Outcomes in Relation to Maternal NCDs

Cesarean section rate was high (46%) in this NCD cohort, reflecting the increased risk of complications.

Table 5. Mode of Delivery in Study Population

Bar graph 1: Distribution of NCDs in pregnancy.

Bar graph 2: Fetal Outcomes in Pregnancies with NCDs.