Clinical spectrum and management outcomes of GDM and GHTN: A case series from a tertiary care center

P. Akshai Ananth

Clinical Pharmacist Trainee, Kauvery Hospital, Maa Kauvery, Trichy, Tamil Nadu

Abstract

Gestational Diabetes Mellitus (GDM) and Gestational Hypertension (GHTN) represent two major pregnancy-associated disorders contributing to maternal and perinatal morbidity and mortality. This case series presents five patients with diverse clinical presentations of GDM and GHTN, highlighting diagnostic challenges and management approaches.

Key words: Gestational Diabetes Mellitus; Gestational Hypertension; Pregnancy Complications; Case Series; Maternal Outcomes

Introduction

Gestational Diabetes Mellitus (GDM) and Gestational Hypertension (GHTN) are among the most common metabolic and vascular disorders encountered during pregnancy. According to the World Health Organization (WHO, 2023), approximately 14% of pregnancies are complicated by GDM, while hypertensive disorders affect up to 10% globally. Both conditions significantly increase the risk of preterm labor, preeclampsia, and perinatal mortality. The management of these disorders requires adherence to established international guidelines (ACOG, WHO, NICE) and individualized care strategies. This case series describes five clinical scenarios managed at a tertiary center, focusing on diagnostic parameters, treatment compliance with global standards, and patient outcomes.

Case Presentation

Five female patients aged 27–32 years were managed for GDM and/or GHTN at a tertiary care hospital. Interventions included insulin therapy, oral hypoglycemics, antihypertensives, and obstetric procedures such as lower segment cesarean section (LSCS) and cervical cerclage Maternal and neonatal outcomes varied from live births to intrauterine fetal demise.

Case series summary

CaseAgeDiagnosisProcedureTreatment SummaryOutcome
128G2P1L1, ITP, GHTN, IUFD (18 weeks)Spontaneous expulsion (340g)Labetalol 100mg (1-0-1)IUFD
227G2P1L1, GDM, 9 monthsEmergency LSCSInsulin Actrapid 6-6-0, Mixtard 0-0-8Live female (2.7kg)
332IVF Twins, Chronic HTN, GDMElective LSCSGlyciphage 500mg, Nicardia 20mg, Labetalol 100mgLive twins (1.9kg & 2.1kg)
432IUI Twins, GDM, Cervical IncompetenceSpontaneous expulsionMetformin 500mg, Nicardia 10mgTwin loss (600g & 560g)
528Primi, Type 1 DM, GHTN, PreeclampsiaOngoing managementLantus (10-0-10), Actrapid (1-1-1), Nicardia 10mg, Labetalol 100mgUnder observation

Comparison with Standard Guidelines

GuidelineGDM ManagementGHTN Management
ACOG (2023)Insulin as first-line; Metformin if insulin not toleratedLabetalol, Methyldopa, or Nifedipine; BP target <140/90 mmHg
WHO (2023)Lifestyle + insulin; Metformin under supervisionLabetalol preferred; avoid ACE inhibitors
NICE (2022)Metformin/Insulin depending on glucose controlLabetalol first-line; consider Nifedipine if ineffective

Results

Management strategies aligned with ACOG, WHO, and NICE recommendations in most cases, particularly in antihypertensive and insulin regimens. However, outcomes were influenced by comorbidities such as chronic hypertension, preeclampsia, and multiple gestations.

Discussion

The management outcomes in this case series demonstrate the critical role of early screening and multidisciplinary coordination in high-risk pregnancies. Insulin therapy remains the mainstay of GDM management, consistent with ACOG and WHO recommendations. For GHTN, Labetalol and Nicardia (Nifedipine) were the antihypertensives of choice, aligning with NICE guidelines. Adverse outcomes, including intrauterine fetal demise and preterm twin loss, highlight the influence of comorbidities such as thrombocytopenia, chronic hypertension, and cervical incompetence.

Studies have shown that timely initiation of therapy and close monitoring significantly reduce complications (Smith et al,2023; Johnson & Lee,2024). This series reaffirms the need for consistent antenatal visits and adherence to therapeutic regimens.

Conclusion

This case series emphasizes that strict glycemic and blood pressure control are essential to improve maternal and perinatal outcomes in pregnancies complicated by GDM and GHTN. Tailored management based on international guidelines should be reinforced across all obstetric care levels. Early screening, individualized therapy, and close perinatal monitoring are critical for optimizing outcomes in pregnancies complicated by GDM and GHTN.

References

  • American College of Obstetricians and Gynecologists. (2023). Practice Bulletin No. 247: Gestational Hypertension and Preeclampsia. Obstetrics & Gynecology.
  • National Institute for Health and Care Excellence (NICE). (2022). Hypertension in pregnancy: Diagnosis and management (NG133).
  • World Health Organization. (2023). Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy.
  • Smith, J., Brown, K., & Lee, H. (2023). Maternal outcomes in gestational diabetes: A global perspective. Journal of Maternal Medicine, 12(4), 210–218.
  • Johnson, A., & Lee, M. (2024). Managing gestational hypertension in developing countries: Current challenges. International Journal of Reproductive Medicine, 18(2), 77–83.

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