Evaluation of Pregnancies with Pre-existing Hypertension and Diabetes (1).cdr

The complications in pregnancy can happen due to diabetes and hypertension which may affect the mother or the fetus. Objective: To evaluate pregnancy in hypertensive and diabetic pregnant women to detect associated risk factors and complications. Methods:The research was a cross-sectional method of study, conducted over 4 months from December 2021 to March 2022 in a private hospital in Gujranwala, Pakistan. A sample size of 50 was considered as per convenience. The data was analyzed using SPSS V20 software. The age of patients considered was minimum 18 years to maximum 50 years . The scan was done using greyscale type 2D Mindary ultrasound equipment. A written consent form was also taken from patients. Results: The results showed that 15(30%) patients were presented with diabetes mellitus, 32(64%) has hypertension and 3(6%) has both hypertension and diabetes mellitus. The complications included low lying placenta and placental abruption in 1(2%), polyhydramnios in 3(6%) and oligohydramnios in 1(2%). Microcephaly was found in 1(2%) and hydrocephalus was seen in 2(4%). Fetal abortion was found in 7(14%) and only 3(6%) have chance of having a fetus with abnormalities due to hypertension and diabetes whereas most of them have normal birth 43(86%) with no complications. Conclusion: In conclusion, the majority of women with diabetes mellitus and hypertension can have a normal pregnancy and birth, but some may face di culties such as intrauterine fetal mortality, fetal congenital abnormalities and defects and still birth. The duration of pregnancy is 280 days, 40 weeks, or 9 months. It is divided into three periods. The 1st period is the 1st trimester which begins from the 1st week to 12 weeks in which the oogenesis is going on [1]. The 2nd period is the 2nd trimester which begins from 13 to 26 weeks, and the last period is the 3rd trimester which begins from 27 till delivery [2]. Pregnancy is a critical duration for both m ot h e r a n d fet u s d u e to s eve ra l p ro b l e m s a n d complications that may occur during this period [3]. These problems include diabetes mellitus, gestational diabetes, hypertension, and induced hypertension [4]. Hypertension is thought to complicate nearly 10% of all pregnancies around the world [5]. These problems lead to reverse outcomes even for mother and fetus such as abortions, malformations, preeclampsia, stillbirth and intrauterine fetal restrictions [6]. One of the most common central nervous system congenital malformations owing to hypertension and diabetes in pregnancy is congenital hydrocephalus [7,8]. Hypertension in pregnancy is de ned as having a systolic blood pressure (BP) of 140 mmHg or higher and a diastolic blood pressure (BP) of 90 mmHg or higher on at least two occasions more than four hours apart when resting [9]. A systolic blood pressure of 160 mmHg or higher and diastolic blood pressure of 110 mmHg or higher reported on two separate occasions is considered severe hypertension [10]. Pregnancy induced hypertension are classi ed into 4 categories: gestational hypertension, preeclampsia/eclampsia, chronic hypertension and preeclampsia superimposed on chronic hypertension [11]. In the United States, hypertension is the most prevalent Original Article Evaluation of Pregnancies with Pre-existing Hypertension and Diabetes I N T R O D U C T I O N Pregnancies with Pre-existing Hypertension and Diabetes 1Department of Allied Health Sciences,University Institute of Radiological Sciences and Medical Imaging, The University of Chenab, Gujrat,Pakistan 1 1 1 1 1 Hateem Qaiser , Akash John , AbidAli , Shehr Bano , Nayyar Ashfaq How to Cite: Qaiser, H. ., John, A. ., Ali, A., Bano, S. ., & Ashfaq, N. . (2022). Evaluation of Pregnancies with Preexisting Hypertension and Diabetes: Pregnancies with Pre-existing Hypertension and Diabetes. DIET FACTOR (Journal of Nutritional &Amp; Food Sciences), 3(1). https://doi.org/10.54393/df.v3i1.44 *Corresponding Author: Hateem Qaiser Department of Allied Health Sciences,University Institute of Radiological Sciences and Medical Imaging, The University of Chenab, Gujrat,Pakistan Qaiser H et al.,

The duration of pregnancy is 280 days, 40 weeks, or 9 months. It is divided into three periods. The 1st period is the 1st trimester which begins from the 1st week to 12 weeks in which the oogenesis is going on [1]. The 2nd period is the 2nd trimester which begins from 13 to 26 weeks, and the last period is the 3rd trimester which begins from 27 till delivery [2]. Pregnancy is a critical duration for both m ot h e r a n d fet u s d u e to s eve ra l p ro b l e m s a n d complications that may occur during this period [3]. These problems include diabetes mellitus, gestational diabetes, hypertension, and induced hypertension [4]. Hypertension is thought to complicate nearly 10% of all pregnancies around the world [5]. These problems lead to reverse outcomes even for mother and fetus such as abortions, malformations, preeclampsia, stillbirth and intrauterine fetal restrictions [6]. One of the most common central nervous system congenital malformations owing to hypertension and diabetes in pregnancy is congenital hydrocephalus [7,8]. Hypertension in pregnancy is de ned as having a systolic blood pressure (BP) of 140 mmHg or higher and a diastolic blood pressure (BP) of 90 mmHg or higher on at least two occasions more than four hours apart when resting [9]. A systolic blood pressure of 160 mmHg or higher and diastolic blood pressure of 110 mmHg or higher reported on two separate occasions is considered severe hypertension [10]. Pregnancy induced hypertension are classi ed into 4 categories: gestational hypertension, preeclampsia/eclampsia, chronic hypertension and preeclampsia superimposed on chronic hypertension [11]. In the United States, hypertension is the most prevalent

Original Article
Evaluation of Pregnancies with Pre-existing Hypertension and Diabetes

I N T R O D U C T I O N
Pregnancies with Pre-existing Hypertension and Diabetes ¹Department of Allied Health Sciences,University Institute of Radiological Sciences and Medical Imaging, The University of Chenab, Gujrat,Pakistan pregnancy problem, affecting 8-10% of pregnancies [12]. The hypertensive disorders of pregnancy continue to be one of the leading causes of pregnancy-related maternal mortality, accounting for 7-12% of all pregnancy-related maternal fatalities each year in United States [13,14]. Diabetes is linked to an increased probability of maternal and newborn morbidity in pregnant women, [15] and it remains a substantial medical problem [16]. It raises the risk of delivery trauma, and cesarean section by increasing the prevalence of macrosomia [17]. Obesity, family history of diabetes, impulsive abortions, and previous pregnancies with gestational diabetes had a increased rate of gestational diabetes mellitus in current pregnancy [18]. In addition, gestational diabetic patients have increased risk o f p e r i n a t a l d e a t h , n e o n a t a l h y p o g l y c e m i a , hyperbilirubinemia, gestational hypertension and preeclampsia [19]. Perinatal outcomes, linked to inadequate glycemic management in mothers, have a 42.9 percent motility rate [20]. When it comes to assessing the fetus during pregnancy, ultrasound has become a necessary component [21]. It is a simple, non-invasive process that can be used to determine whether or not a woman is pregnant [22,23]. It was previously used to con rm pregnancy in the rst trimester, whether positive or negative, gestational age, and the number of children [24]. Ultrasound evaluates gender, number of gestational sacs, anticipated delivery date, amniotic uid volume, placenta site and size and fetal anomalies [25]. This study was used to assess pregnancy in hypertensive and diabetic pregnant women, as well as the detection of hypertension and d i a b e t e s -r e l a t e d c o m p l i c a t i o n s l i k e a b o r t i o n, polyhydramnios, oligohydramnios, placental site abnormalities and fetal malformations. The importance of ultrasound as an early diagnostic tool and prediction of hypertension and diabetes related problems in pregnancy will be highlighted in this study.

M E T H O D S
The research was a cross-sectional method of study, conducted over 4 months from December 2021 to March 2022. A sample size of 50 was considered as per convenience. The age of patients for this study was minimum 18 years to maximum 50 years who had undergone ultrasonography. This study was conducted in the department of radiology in a private hospital in Gujranwala, Pakistan. The scan was done using greyscale type 2D Mindary ultrasound equipment. A written consent form was also taken from patients. The data were analyzed using SPSS version 20.0. Table 1 shows that the second group (25-40 years) with maximum frequency 39(78%) of the sample as compared to the rst group (under 25 years) with 8(16%) of the sample and the third group (40 years and more) with minimum frequency 3(6%) of the sample.

R E S U L T S
This study was conducted by dividing patients into three age groups, ranging from under 20 to above 43 years old.

Age Groups
Frequency Percent   Table 2 shows that there is a higher incidence of hypertension 32(64%), followed by 15(30%) of diabetes mellitus and the least incidence of having both hypertension and diabetes mellitus that is only 3(6%).   Table 3 shows that there is a higher incidence of having normal placental site 48(96%), but only 1(2%) are presented with the low lying placenta and 1(2%) with placental abruption.   Table 4 shows that normal amniotic uid volume was found in 46(92%), with polyhydramnios present in 3(6%) and least were presented with oligohydramnios in 1(2%).   Table 5 shows that there is less chance of fetal abortion 7(14%) due to hypertension and diabetes whereas most have normal birth 43(86%).   Table 6 shows that patients with diabetes and hypertension had an 3(6%) chance of having a fetus with abnormalities:

D I S C U S S I O N C O N C L U S I O N
This study was conducted using ultrasonography to analyze pregnancy in diabetic and hypertensive women in Gujranwala, Pakistan, by analyzing amniotic uid volume, placenta site, abortions, and fetal malformations. A total of 50 pregnant diabetic and hypertensive women were scanned to determine their pregnancy status from the perspective of the prior issues. The current study showed that 39 (78%) of the pregnant women affected by hypertension and diabetes mellitus are from 25-40 years of age while only 8 (16%) of female below 25 years of age and 3 (6%) of female above 40 years were affected with diabetes and hypertension in the current study, it was proved that pregnant women in the adult age group most commonly affected with complications due to hypertension and diabetes. A previous study was done by Bener et al 2011 also mentioned that adult age pregnancy also affected by complications due to gestational diabetes [15]. Among these most of the women were affected by hypertension i.e.-32 (64%), 15 (30%) had diabetes mellitus and only 3 (6%) of women are affected by both diabetes and hypertension. A previous study done by Mahmoud 2019 also found that m o st of t h e p re g n a n t wo m e n we re af fe c te d by hypertension. It is also shown in this study that 48 (96%) of women with diabetes and hypertension have a normal placental site and only 1 (2%) are presented with the lowlying placenta and 1 (2%) placental abruption [2]. The volume of amniotic uid was normal in 46 (92%) of women with 3 (6%) having polyhydramnios and 1 (2%) having oligohydramnios. Mahmoud 2019 also proved that there were more normal placental sites but can cause low lying and placental abruption in very less cases [2]. He also mentioned that there are more normal amniotic uid volume due to hypertension and diabetes and has very less polyhydramnios and oligohydramnios in a few cases. There are only 7 (14%) abortions due to diabetes and hypertension in pregnancy whereas in 43 (86%) there is normal bir th. 47 (94%) of pregnant women with hypertension and diabetes had no incidence of any fetal anomaly while 2 (4%) of a fetus is presented with hydrocephaly and 1 (2%) of the fetus is presented with microcephaly. Mahmoud 2019 also proved that there are fewer abortions due to hypertension and diabetes and had lesser incidence of fetal anomalies [2].
This study concluded that the majority of women with diabetes mellitus/ hypertension can have a normal pregnancy and birth, but some may have di culties such as fetal congenital abnormalities and defects, and stillbirth. Age is a continuous risk factor for diabetes/ hypertension during pregnancy. The diabetes and hypertension-related problems include abortions, p l a c e n t a s i t

R E F E R E N C E S
Microcephaly was found in 1(2%) and hydrocephalus was seen in 2(4%).