Pregnancy-induced Hypertension in Rural Areas
Year: 2025
Type: article
Abstract: Dear Editor, ‘Hypertensive disorders of pregnancy, including pre-eclampsia, are a leading cause of maternal mortality worldwide, accounting for at least 14% of all maternal deaths, with the highest burden seen in low-resource rural settings’. – The World Health Organization, Maternal Mortality Fact Sheet, 2023.[1] We are grateful for the thoughtful appreciation and critical appraisal of our article pregnancy-induced hypertension (PIH): What are the associated factors in rural areas? A study from rural Dehradun, Uttarakhand published in the January–March 2025 issue of the journal.[2] PIH continues to be an important cause of maternal and perinatal complications, a concern that is particularly evident in rural and hilly regions where access to timely and comprehensive healthcare services may be limited.[3] Through our study, we endeavoured to contribute to this area of knowledge by systematically examining the sociodemographic and obstetric factors associated with PIH, using extensive field data and statistical analysis. We sincerely appreciate the observation that ‘early identification of at-risk groups is crucial,’ as this aligns closely with our interpretation of the findings. Similar evidence has been reported from rural Uttarakhand, where focussed antenatal screening and timely interventions have been shown to improve outcomes amongst women with hypertensive disorders of pregnancy.[4] We appreciate the recognition of our effort and concur that prompt management of modifiable risk factors can significantly reduce the disease burden. We hope that our findings encourage more studies in other rural and hilly belts to develop region-specific preventive strategies. We sincerely appreciate the detailed assessment of our work and the thoughtful observations shared. With respect to the distribution of participants by religion [Table 1], 98% of the women in our study population identified as Hindus. This distribution reflects the demographic characteristics of the villages included in our sampling frame and does not indicate any intentional exclusion of other groups. Similar trends have been documented in previous research from hilly regions; for example, Kandpal et al. reported that over 90% of their antenatal cohort in rural Uttarakhand comprised women from the Hindu community, which is consistent with the predominant religious composition of those catchment areas.[4] Similarly, Kaur et al., in a study conducted amongst antenatal women in rural Himachal Pradesh, also reported a predominantly Hindu sample owing to the local population profile.[5] Although state-level census data show a higher proportion of Muslim residents overall, the specific villages selected for our study had only a limited representation of this group, which likely accounts for the observed imbalance.Table 1: Sociodemographic profile of study participants seeking antenatal services at subcentresWith respect to the obstetric history presented in Table 2, 15 out of 113 women in our study were identified as overweight or obese. Existing literature clearly indicates that excess maternal body weight is a well-recognised risk factor for hypertensive disorders of pregnancy as well as gestational diabetes. For instance, a cohort study conducted in Himachal Pradesh by Negi et al. reported that women with elevated body mass index (BMI) had a significantly higher likelihood of developing PIH, compared to those with a normal BMI.[6] Similarly, research, by Kumar M et al. demonstrated that increased pre-pregnancy BMI was strongly associated with higher rates of both pre-eclampsia and gestational diabetes in hilly regions, where dietary habits and physical activity levels differ from those in the plains.[7] In our own analysis, BMI also showed a positive correlation with PIH; however, the association did not reach statistical significance in the final regression model, suggesting that studies with larger sample sizes may be necessary to confirm these trends.Table 2: Obstetric history and other variables of pregnant womenseeking antenatal care services at subcentresWith regard to the impact of COVID-19, our fieldwork was undertaken during the period of pandemic restrictions, and all data collection procedures were conducted in accordance with recommended COVID-19-appropriate protocols. Evidence from previous research has demonstrated that COVID-19 infection during pregnancy is associated with an elevated risk of pre-eclampsia, pre-term birth and gestational diabetes; for example, Allotey et al. reported these associations in a comprehensive meta-analysis across multiple countries.[8] Similarly, a review by Villar et al. highlighted that pregnant women infected with SARS-CoV-2 are at increased risk for hypertensive disorders and other adverse outcomes.[9] In our cohort, no participants reported a confirmed COVID-19 infection during antenatal assessments. Nevertheless, we acknowledge that future investigations, particularly in rural and resource-limited settings, would benefit from systematically capturing COVID-19 status and other co-existing infections to better delineate their potential contribution to the development of PIH. Regarding Table 2’s reporting of preterm and term deliveries, we acknowledge that a typographical error led to inconsistent denominators. The total cohort was 113 women, and the corrected data align both headers with the same denominator. Such discrepancies are unintended, and we appreciate the opportunity to rectify them. Regarding Table 3’s distinction between ‘present’ and ‘past’ history of diabetes, the categorisation was done to differentiate two clinically distinct conditions. The term ‘history of diabetes’ in our dataset refers to women who had a preexisting diagnosis of diabetes mellitus before the index pregnancy. In contrast, ‘present history of diabetes’ refers to women who were newly diagnosed with gestational diabetes mellitus during the current pregnancy through routine antenatal screening. As noted by Macaulay et al., pregestational and gestational diabetes are epidemiologically and clinically distinct entities, with different implications for both mother and foetus.[10]Table 3: Medical history and related conditions of pregnant womenseeking antenatal care services at subcentresWe appreciate the critical insights which have allowed us to provide these clarifications and strengthen the interpretation of our findings. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Source: Journal of Medical Evidence
Authors: Manisha Dhinwa, Pradeep Aggarwal, Mahendra Singh, Yogesh Bahurupi, Nandita Sharma
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7108082362