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Hypertensive disorders of pregnancy and risk of diabetes in Indian women: A cross-sectional study
Authors: Agrawal S, and Fledderjohann J
Source: BMJ Open, 6(8): e011000; DOI: 10.1136/bmjopen-2015-011000
Topic(s): Diabetes
Maternal health
Reproductive health
Country: Asia
Published: AUG 2016
Abstract: Epidemiological data from high-income countries suggest that women with hypertensive disorders of pregnancy (HDP) are more likely to develop diabetes later in life. Objective: We investigated the association between pre-eclampsia and eclampsia (PEandE) during pregnancy and the risk of diabetes in Indian women. Design Cross-sectional study. Setting India. Methods: Data from India's third National Family Health Survey (NFHS-3, 2005-2006), a cross-sectional survey of women aged 15-49 years, are used. Self-reported symptoms suggestive of PEandE were obtained from 39657 women who had a live birth in the 5years preceding the survey. The association between PEandE and self-reported diabetes status was assessed using multivariable logistic regression models adjusting for dietary intake, body mass index (BMI), tobacco smoking, alcohol drinking, frequency of TV watching, sociodemographic characteristics and geographic region. Results: The prevalence of symptoms suggestive of PEandE in women with diabetes was 1.8% (n=207; 95% CI 1.5 to 2.0; p<0.0001) and 2.1% (n=85; 95% CI 1.8 to 2.3; p<0.0001), respectively, compared with 1.1% (n=304; 95% CI 1.0 to 1.4) and 1.2% (n=426; 95% CI 1.1 to 1.5) in women who did not report any PEandE symptoms. In the multivariable analysis, PEandE was associated with 1.6 times (OR=1.59; 95% CI 1.31 to 1.94; p<0.0001) and 1.4 times (OR=1.36; 95% CI 1.05 to 1.77; p=0.001) higher risk for self-reported diabetes even after controlling for dietary intake, BMI and sociodemographic characteristics. Conclusions: HDP is strongly associated with the risk of diabetes in a large nationally representative sample of Indian women. These findings are important for a country which is already tackling the burden of young onset of diabetes in the population. However, longitudinal medical histories and a clinical measurement of diabetes are needed in this low-resource setting. Keywords: diabetes; eclampsia; India; NFHS-3; Preeclampsia