Temporal patterns and adverse pregnancy outcomes of hypertensive disorders of pregnancy and gestational diabetes mellitus in Hebei Province, China, 2017–2023: a multicenter retrospective cohort study
- 1Department of Obstetrics and Gynecology, Hebei General Hospital
- 2Department of Information Management, Hebei Center for Women and Children’s Health
Abstract
Background: Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are common complications with overlapping metabolic, vascular, and inflammatory pathways. GDM is associated with fetal overgrowth but may also coexist with fetal growth restriction, particularly when placental vascular dysfunction is present. Regional evidence on recorded temporal patterns and joint maternal-neonatal outcomes remains limited in northern China.
Methods: We analyzed 264,278 eligible singleton deliveries at ≥28 gestational weeks recorded in the Hebei Obstetric Critical Illness Monitoring System across 31 hospitals from 2017 to 2023. Pregnancies were classified as HDP alone, GDM alone, coexisting HDP and GDM, or unaffected. Multivariable logistic regression adjusted for maternal age, marital status, education, hospital level, gravidity, parity, prenatal examination frequency, and previous cesarean section. Sensitivity analyses examined center composition and hospital-specific random intercepts. Associations were interpreted as non-causal because important metabolic and behavioral covariates were unavailable.
Results: Of eligible deliveries, 11,708 (4.43%) had HDP alone, 18,600 (7.04%) had GDM alone, 2,138 (0.81%) had coexisting HDP-GDM, and 231,832 (87.72%) were unaffected. The recorded prevalence of HDP alone rose from 3.42% in 2017 to 7.60% in 2023. GDM alone and coexisting HDP-GDM peaked in 2021 (13.21 and 1.39%) and then fell abruptly in 2022–2023. HDP alone showed the strongest associations with placental abruption, preterm delivery, small-for-gestational-age birth, and neonatal asphyxia; GDM alone was associated with macrosomia and premature rupture of membranes; the combined group had a mixed risk profile. Estimates for stillbirth and puerperal infection in the combined group were imprecise because only one and two events, respectively, occurred.
Conclusion: HDP, GDM, and their coexistence were associated with distinct but overlapping outcome profiles. The abrupt post-2021 decline in recorded GDM persisted in center-composition sensitivity analyses but cannot be interpreted as a confirmed population-level decline because screening and ascertainment differences remain unresolved. The results support cautious, guideline-concordant integrated surveillance rather than study-derived monitoring thresholds.
Related
- Real-world discrimination and incremental value of first-trimester placental growth factor for hypertensive disorders of pregnancy: a retrospective Chinese cohort
- Associations of early-pregnancy triiodothyronine and triglycerides with hypertensive disorders of pregnancy: a retrospective cohort study
- Hypertension in People with Multiple Sclerosis: Epidemiology, Mechanisms, Hypertensive Disorders of Pregnancy, and Clinical Implications.
- Causal effects of physical activity and sedentary behaviors on hypertensive disorders of pregnancy: a two-sample Mendelian randomization study
- County-Level Structural Racism and Racial Disparities in Hypertensive Disorders of Pregnancy in Georgia
BibTeX
@article{liu2026temporal,
title = {{Temporal patterns and adverse pregnancy outcomes of hypertensive disorders of pregnancy and gestational diabetes mellitus in Hebei Province, China, 2017–2023: a multicenter retrospective cohort study}},
author = {Li Liu and Suxin Liu and Liyan Du and Xiaoqian Yin and Yan Huo},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1885150},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1885150/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Temporal patterns and adverse pregnancy outcomes of hypertensive disorders of pregnancy and gestational diabetes mellitus in Hebei Province, China, 2017–2023: a multicenter retrospective cohort study
AU - Li Liu
AU - Suxin Liu
AU - Liyan Du
AU - Xiaoqian Yin
AU - Yan Huo
PY - 2026
DA - 2026/10/22
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1885150
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1885150/full
AB - Background: Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are common complications with overlapping metabolic, vascular, and inflammatory pathways. GDM is associated with fetal overgrowth but may also coexist with fetal growth restriction, particularly when placental vascular dysfunction is present. Regional evidence on recorded temporal patterns and joint maternal-neonatal outcomes remains limited in northern China. Methods: We analyzed 264,278 eligible singleton deliveries at ≥28 gestational weeks recorded in the Hebei Obstetric Critical Illness Monitoring System across 31 hospitals from 2017 to 2023. Pregnancies were classified as HDP alone, GDM alone, coexisting HDP and GDM, or unaffected. Multivariable logistic regression adjusted for maternal age, marital status, education, hospital level, gravidity, parity, prenatal examination frequency, and previous cesarean section. Sensitivity analyses examined center composition and hospital-specific random intercepts. Associations were interpreted as non-causal because important metabolic and behavioral covariates were unavailable. Results: Of eligible deliveries, 11,708 (4.43%) had HDP alone, 18,600 (7.04%) had GDM alone, 2,138 (0.81%) had coexisting HDP-GDM, and 231,832 (87.72%) were unaffected. The recorded prevalence of HDP alone rose from 3.42% in 2017 to 7.60% in 2023. GDM alone and coexisting HDP-GDM peaked in 2021 (13.21 and 1.39%) and then fell abruptly in 2022–2023. HDP alone showed the strongest associations with placental abruption, preterm delivery, small-for-gestational-age birth, and neonatal asphyxia; GDM alone was associated with macrosomia and premature rupture of membranes; the combined group had a mixed risk profile. Estimates for stillbirth and puerperal infection in the combined group were imprecise because only one and two events, respectively, occurred. Conclusion: HDP, GDM, and their coexistence were associated with distinct but overlapping outcome profiles. The abrupt post-2021 decline in recorded GDM persisted in center-composition sensitivity analyses but cannot be interpreted as a confirmed population-level decline because screening and ascertainment differences remain unresolved. The results support cautious, guideline-concordant integrated surveillance rather than study-derived monitoring thresholds.
SN - 2296-2565
ER -