A Comprehensive Review of Maternal Metabolic and Hypertensive Disorders During Pregnancy

Abstract

Introduction: Globally, maternal and perinatal morbidity and mortality are significantly influenced by maternal metabolic and hypertensive disorders, such as gestational diabetes mellitus (GDM), thyroid dysfunction, and hypertensive disorders of pregnancy (HDP). These conditions often coexist and share overlapping pathophysiological mechanisms, yet their combined impact on pregnancy outcomes has not been fully synthesized in the literature.

Objectives: To comprehensively review the epidemiology, clinical characteristics, maternal–foetal outcomes, and management strategies related to maternal diabetes, thyroid dysfunction, and hypertensive disorders during pregnancy.

Methods: A comprehensive search of major scientific databases yielded pertinent studies on metabolic and hypertensive diseases during pregnancy. Eligible studies were screened for relevance, and findings were synthesized qualitatively to capture prevailing evidence on prevalence, risk factors, maternal and neonatal outcomes, and clinical implications.

Results: Thirty studies were included in the qualitative synthesis. Preeclampsia, preterm birth, caesarean delivery, macrosomia, NICU admission, stillbirth, congenital abnormalities, and long-term maternal cardiometabolic disease have all been linked to GDM and pregestational diabetes mellitus (PGDM). HDP, including gestational hypertension and preeclampsia, was strongly linked to preterm delivery, foetal growth restriction, severe maternal morbidity, ICU admission, and perinatal mortality. Increased risks of hypertensive diseases and gestational diabetes have been linked to thyroid malfunction, namely subclinical hypothyroidism and isolated hypothyroxinaemia. Coexisting metabolic and hypertensive disorders demonstrated additive or synergistic effects, substantially amplifying adverse maternal and perinatal outcomes.

Conclusions: Reducing maternal and perinatal problems during pregnancy requires integrated diagnosis and treatment of diabetes, thyroid dysfunction, and hypertensive diseases. Early risk-based and multidisciplinary care may improve pregnancy outcomes and mitigate long-term cardiometabolic risk for both mothers and offspring.