Pharmacological Management of Gestational Hypertension and Diabetes: A Cross-Sectional Study in Tertiary Hospitals of Faisalabad, Pakistan

Abstract

Background: Gestational hypertension (GH) and gestational diabetes mellitus (GDM) drive substantial maternal–neonatal morbidity in low-resource settings, where screening pathways, pharmacotherapy, and supply chains are variable. Objective: To quantify prescribing patterns and guideline-concordant therapy for GH/GDM and identify patient- and system-level predictors of adherence and medication availability in tertiary hospitals of Faisalabad, Pakistan. Methods: We conducted a multi-center cross-sectional study (December 2024–May 2025). Hospital logs (N=10,500) provided prevalence; an analytic cohort of pregnant women with confirmed GH and/or GDM (n=379) completed structured interviews with record verification. Primary outcome was guideline-concordant pharmacotherapy; secondary outcomes were adherence (good/poor) and medication availability (never/sometimes/always). Multivariable logistic, multinomial, and ordinal models adjusted for prespecified confounders; effects are reported as odds ratios (OR) with 95% CIs. Results: In logs, GH prevalence was 2.21%, GDM 1.05%, and co-occurrence 0.35%. In the cohort, diagnoses were GH 61.2%, GDM 29.0%, and both 9.8%. Methyldopa (55.9%) and metformin (31.9%) predominated; insulin use was 0.53%. Knowledge of GH/GDM favored adherence (OR 0.29, 95% CI 0.16–0.52), and balanced diet improved adherence with stronger effects in overweight/obese strata (e.g., Overweight Balanced OR 24.98, 95% CI 3.99–156.42). Knowledge” was associated with higher recorded complications (mild OR 1.84; severe OR 6.98), consistent with surveillance/detection rather than causal harm. Medication availability was higher at Allied (OR 1.94 vs DHQ) and lower at Government General (OR 0.42); rural residence reduced availability (OR 0.24). Conclusion: Pharmacological management favored methyldopa and metformin with strikingly low insulin uptake, and availability varied by hospital and residence. Standardized screening, insulin pathways, targeted nutrition counseling, and supply-chain stabilization are immediate priorities.