A global view of hypertensive disorders and diabetes mellitus during pregnancy

Probably not a substantial claim: may not pass S3 (load-bearing).

Hypertensive disorders in pregnancy remain a leading cause of maternal mortality and morbidity globally, especially in low-income and middle-income countries.

“Despite decreasing prevalence after years of interventions, HDP remain a leading cause of maternal mortality and morbidity globally, especially in low-income and middle-income countries (LMICs)2–4.”

• cites [2] Steegers, E. A., von Dadelszen, P., Duvekot, J. J. & Pijnenborg, R. Pre-eclampsia. Lancet 376, 631–644 (2010). sourceNot checked — no full text of the source
• cites [3] Say, L. et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob. Health 2, e323–e333 (2014). sourcePartly supported

  The Results (p. 5) identify hypertensive disorders as the second most common direct cause of maternal death worldwide, and the Introduction (p. 1) describes them as a leading cause of maternal mortality in developing regions. The paper does not establish that they are a leading cause of maternal morbidity or that their prevalence has decreased after interventions. (LLM, conf=0.88)

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• cites [4] Duley, L. The global impact of pre-eclampsia and eclampsia. Semin. Perinatol. 33, 130–137 (2009). sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Pre-eclampsia is not a single disorder but a variety of pathophysiological pathways converging on a common syndromic end point of high blood pressure with proteinuria after 20 weeks of pregnancy.

“Pre-eclampsia is not a single disorder but a variety of pathophysiological pathways that converge on a common syndromic end point, of high blood pressure occurring with proteinuria after 20 weeks of pregnancy13.”

• cites [13] Roberts, J. M. & Bell, M. J. If we know so much about preeclampsia, why haven’t we cured the disease? J. Reprod. Immunol. 99, 1–9 (2013). sourcePartly supported

  Section 5 (‘Subtypes of preeclampsia?’, page unavailable) argues that preeclampsia may comprise different subtypes with different pathophysiological pathways, but presents this as a hypothesis to test rather than an established fact. Section 2.2 identifies hypertension and proteinuria as diagnostic criteria. Our copy does not establish the claim’s ‘after 20 weeks’ threshold. (LLM, conf=0.86)

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May combine two claims.

Pregnant people with hypertensive disorders in pregnancy or impaired glucose metabolism have an increased risk of future cardiometabolic disorders and premature death later in life.

“Furthermore, pregnant people with HDP or impaired glucose metabolism have an increased risk of future CMDs and premature death later in life8–10.”

• cites [8] Rich-Edwards, J. W., Fraser, A., Lawlor, D. A. & Catov, J. M. Pregnancy characteristics and women’s future cardiovascular health: an underused opportunity to improve women’s health? Epidemiol. Rev. 36, 57–70 (2014). sourcePartly supported

  The Materials and Methods section reports increased later diabetes and cardiovascular disease after antepartum hyperglycemia, and increased cardiovascular disease after hypertensive disorders of pregnancy. It also reports higher cardiovascular mortality after preeclampsia, but does not establish increased premature death after impaired glucose metabolism or increased all-cause premature death for either group (page numbers unavailable). (LLM, conf=0.86)

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• cites [9] Hauspurg, A., Ying, W., Hubel, C. A., Michos, E. D. & Ouyang, P. Adverse pregnancy outcomes and future maternal cardiovascular disease. Clin. Cardiol. 41, 239–246 (2018). sourceNot checked — no full text of the source
• cites [10] Heida, K. Y. et al. Cardiovascular risk management after reproductive and pregnancy-related disorders: a Dutch multidisciplinary evidence-based guideline. Eur. J. Prev. Cardiol. 23, 1863–1879 (2016). sourcePartly supported

  The Hypertensive disorders of pregnancy section (p. 4) reports increased risks of later cardiovascular disease or death from cardiovascular disease after preeclampsia or gestational hypertension, as well as increased risks of some cardiometabolic conditions. The Introduction (p. 3) says gestational diabetes was excluded from this guideline; the Polycystic ovary syndrome section (p. 12) notes a later type 2 diabetes risk after gestational diabetes, but does not establish the broader cardiovascular or premature-death claim for impaired glucose metabolism. The paper reports cardiovascular mortality after HDP, not premature death generally. (LLM, conf=0.88)

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May combine two claims.

Hypertensive disorders in pregnancy and hyperglycaemia during pregnancy negatively affect fetuses and neonates, including intrauterine growth restriction, macrosomia, preterm birth, low birthweight and adverse outcomes later in life.

“Negative influences of HDP and hyperglycaemia during pregnancy on fetuses and neonates include, but are not limited to, intrauterine growth restriction (IUGR) and macrosomia, preterm birth, low birthweight and adverse outcomes later in life11.”

• cites [11] Morken, N. H., Halland, F., DeRoo, L. A., Wilcox, A. J. & Skjaerven, R. Offspring birthweight by gestational age and parental cardiovascular mortality: a population-based cohort study. BJOG 125, 336–341 (2018). sourceCould not verify

  The Methods and Discussion (page unavailable) examine offspring birth size and gestational age in relation to parental cardiovascular mortality and maternal diabetes in a subsequent pregnancy. Searches for hypertensive disorders, pregnancy hyperglycaemia, fetal growth restriction, macrosomia, and later offspring outcomes found no passage addressing the claimed effects of those conditions on fetuses or neonates. (LLM, conf=0.75)

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Probably not a substantial claim: may not pass S3 (load-bearing).

The definition of pre-eclampsia has been extended to include individuals without proteinuria but with evidence of maternal end-organ or uteroplacental dysfunction.

“In the past 10 years, the definition of pre-eclampsia has been extended to include individuals without proteinuria but with evidence of maternal end-organ or uteroplacental dysfunction14.”

• cites [14] Roberts, J. M., Rich-Edwards, J. W., McElrath, T. F., Garmire, L. & Myatt, L. Subtypes of preeclampsia: recognition and determining clinical usefulness. Hypertension 77, 1430–1441 (2021). sourcePartly supported

  The Introduction’s ‘Evidence for subtypes of preeclampsia’ section describes preeclampsia as new-onset gestational hypertension with proteinuria or other systemic findings, supporting inclusion without proteinuria. The copy does not establish that uteroplacental dysfunction is an alternative diagnostic criterion or date the extension of the definition to the past 10 years. No page number is available in our copy. (LLM, conf=0.84)

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No global consensus exists on diagnostic criteria for hypertensive disorders in pregnancy and gestational diabetes mellitus, which makes comparing disease burden across countries difficult.

“A global consensus has not been reached about the diagnostic criteria for HDP and GDM, making it challenging to assess differences in their disease burden between countries and areas.”

• Also stated in: § GDM · plain

  “Currently, the screening and diagnostic approaches for GDM are under debate24–32 given differences in the focus of different guidelines.”

• cites [24] O’Sullivan, E. P. et al. Atlantic Diabetes in Pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria. Diabetologia 54, 1670–1675 (2011). sourcePartly supported

  The Discussion (page unavailable) says that worldwide GDM prevalence estimates depend on the diagnostic criteria used; the study found 12.4% using IADPSG criteria versus 9.4% using WHO criteria. This supports the difficulty of comparing GDM burden, but the paper does not establish a lack of global consensus on diagnostic criteria for hypertensive disorders of pregnancy or a resulting difficulty comparing their burden. (LLM, conf=0.85)

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• cites [25] Bodmer-Roy, S., Morin, L., Cousineau, J. & Rey, E. Pregnancy outcomes in women with and without gestational diabetes mellitus according to the International Association of the Diabetes and Pregnancy Study Groups criteria. Obstet. Gynecol. 120, 746–752 (2012). sourceNot checked — no full text of the source
• cites [26] Mayo, K., Melamed, N., Vandenberghe, H. & Berger, H. The impact of adoption of the International Association of Diabetes in Pregnancy Study Group criteria or the screening and diagnosis of gestational diabetes. Am. J. Obstet. Gynecol. 212, e221–e229 (2015). sourceNot checked — no full text of the source
• cites [27] Trujillo, J. et al. Impact of the International Association of Diabetes and Pregnancy Study Groups criteria for gestational diabetes. Diabetes Res. Clin. Pract. 108, 288–295 (2015). sourceNot checked — no full text of the source
• cites [28] Ramezani Tehrani, F., Naz, M. S. G., Yarandi, R. B. & Behboudi-Gandevani, S. The impact of diagnostic criteria for gestational diabetes mellitus on adverse maternal outcomes: a systematic review and meta-analysis. J. Clin. Med. 10, 666 (2021). sourcePartly supported

  The Introduction (page unavailable) says that the lack of an evidence-based international definition of GDM may affect accurate estimation of adverse maternal-outcome risk, and the Discussion describes continuing controversy over GDM diagnostic criteria. The paper does not make the corresponding claim about diagnostic criteria for hypertensive disorders of pregnancy or specifically say that differences in disease burden between countries are difficult to assess. (LLM, conf=0.88)

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• cites [29] Hartling, L. et al. Diagnostic thresholds for gestational diabetes and their impact on pregnancy outcomes: a systematic review. Diabet. Med. 31, 319–331 (2014). sourceNot checked — no full text of the source
• cites [30] Feldman, R. K., Tieu, R. S. & Yasumura, L. Gestational diabetes screening: the International Association of the Diabetes and Pregnancy Study Groups compared with Carpenter–Coustan screening. Obstet. Gynecol. 127, 10–17 (2016). sourceNot checked — no full text of the source
• cites [31] Saccone, G., Khalifeh, A., Al-Kouatly, H. B., Sendek, K. & Berghella, V. Screening for gestational diabetes mellitus: one step versus two step approach. A meta-analysis of randomized trials. J. Matern. Fetal Neonatal Med. 33, 1616–1624 (2020). sourceNot checked — no full text of the source
• cites [32] Brown, F. M. & Wyckoff, J. Application of one-step IADPSG versus two-step diagnostic criteria for gestational diabetes in the real world: impact on health services, clinical care, and outcomes. Curr. Diab. Rep. 17, 85 (2017). sourcePartly supported

  The Introduction reports a global lack of consensus on GDM diagnostic criteria. The section “Prevalence of GDM With the Application of IADPSG Criteria” says differing criteria confound comparisons between countries. The supplied passages do not address diagnostic criteria for hypertensive disorders in pregnancy (HDP), so the source supports only the GDM part of the claim. (LLM, conf=0.91)

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Probably not a substantial claim: may not pass S3 (load-bearing).

In low-income and middle-income countries, 10-15% of direct maternal deaths are associated with hypertensive disorders in pregnancy.

“In contrast, in LMICs, 10–15% of direct maternal deaths are associated with HDP3,4.”

• cites [3] Say, L. et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob. Health 2, e323–e333 (2014). sourcePartly supported

  The Results (p. 5) identify hypertensive disorders as a major direct cause and estimate that they account for 14.0% of maternal deaths worldwide. That percentage uses all maternal deaths as its denominator, not direct maternal deaths, and the paper does not give a 10–15% estimate specifically for LMICs. The Results (p. 6) also note substantial regional variation. (LLM, conf=0.88)

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• cites [4] Duley, L. The global impact of pre-eclampsia and eclampsia. Semin. Perinatol. 33, 130–137 (2009). sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The WHO estimates the incidence of hypertensive disorders in pregnancy in developing countries at 2.8% of live births, compared with 0.4% in developed countries.

“The WHO’s estimate of the incidence of HDP in developing countries is 2.8% of live births, compared to an incidence of 0.4% of live births in developed countries3.”

• cites [3] Say, L. et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob. Health 2, e323–e333 (2014). sourceCould not verify

  The Summary (p. 1) and Results (pp. 5–6) report the proportion of maternal deaths attributed to hypertensive disorders, not their incidence per live birth. Searches for the claimed 2.8% and 0.4% incidence estimates found no passage supporting either figure. (LLM, conf=0.76)

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May combine two claims.

Hypertensive disorders in pregnancy and gestational diabetes mellitus share several risk factors, including advanced maternal age, overweight or obesity, nutrition such as reduced calcium and vitamin D3 intake, and dietary patterns before and/or during pregnancy.

“HDP and GDM share several risk factors, including advanced maternal age55–64, overweight or obesity56,63,65–70, nutrition (such as reduced calcium and vitamin D3 intake71–77) and dietary patterns before and/or during pregnancy.”

• cites [55] Ananth, C. V., Keyes, K. M. & Wapner, R. J. Pre-eclampsia rates in the United States, 1980–2010: age-period-cohort analysis. BMJ 347, f6564 (2013). sourcePartly supported

  The Abstract (page unavailable) reports greater pre-eclampsia risk at the extremes of maternal age, and the Introduction and Discussion identify obesity as a risk factor for pre-eclampsia. The paper does not establish that age or obesity are also risk factors for gestational diabetes, so it does not fully support the claim that these risks are shared. The nutrition examples have separate citations in the printed sentence. (LLM, conf=0.86)

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• cites [56] Ye, C. et al. The 2011 survey on hypertensive disorders of pregnancy (HDP) in China: prevalence, risk factors, complications, pregnancy and perinatal outcomes. PLoS ONE 9, e100180 (2014). sourcePartly supported

  The Results section (‘The Possible Risk Factors for HDP’; page unavailable) identifies advanced maternal age and pre-pregnancy overweight or obesity as risk factors for HDP. It does not establish that these are also risk factors for GDM, or address reduced calcium or vitamin D3 intake or dietary patterns as shared risk factors. (LLM, conf=0.85)

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• cites [57] Ma, R. et al. Study on the descriptive epidemiology of pregnancy-induced hypertension from 1995–2000 in Jiaxing of Zhejiang province, China [Chinese]. Zhonghua Liu Xing Bing Xue Za Zhi 26, 960–963 (2005).Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [58] Abalos, E. et al. Pre-eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization multicountry survey on maternal and newborn health. BJOG 121, s14–s24 (2014). sourceNot checked — no full text of the source
• cites [59] de Vienne, C. M., Creveuil, C. & Dreyfus, M. Does young maternal age increase the risk of adverse obstetric, fetal and neonatal outcomes: a cohort study. Eur. J. Obstet. Gynecol. Reprod. Biol. 147, 151–156 (2009). sourceNot checked — no full text of the source
• cites [60] Li, Y. et al. Maternal age and the risk of gestational diabetes mellitus: a systematic review and meta-analysis of over 120 million participants. Diabetes Res. Clin. Pract. 162, 108044 (2020). sourceNot checked — no full text of the source
• cites [61] Laine, M. K. et al. Gestational diabetes in primiparous women–impact of age and adiposity: a register-based cohort study. Acta Obstet. Gynecol. Scand. 97, 187–194 (2018). sourceNot checked — no full text of the source
• cites [62] Schummers, L. et al. Absolute risks of obstetric outcomes risks by maternal age at first birth: a population-based cohort. Epidemiology 29, 379–387 (2018). sourceSupported
• cites [63] Lee, K. W. et al. Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. BMC Pregnancy Childbirth 18, 494 (2018). sourceSupported
• cites [64] Eades, C. E., Cameron, D. M. & Evans, J. M. M. Prevalence of gestational diabetes mellitus in Europe: a meta-analysis. Diabetes Res. Clin. Pract. 129, 173–181 (2017). sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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May combine two claims.

A 2021 study using Global Burden of Disease data showed that death and incidence rates of hypertensive disorders in pregnancy are decreasing in most countries and all regions except those with low sociodemographic index and human development index.

“A 2021 study investigating the epidemiological trends of HDP by using the GBD data showed that the death and incidence rates of HDP are decreasing in most countries and all regions except for those with low SDI and HDI49.”

• cites [49] Wang, W. et al. Epidemiological trends of maternal hypertensive disorders of pregnancy at the global, regional, and national levels: a population‐based study. BMC Pregnancy Childbirth 21, 364 (2021). sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

In a global observational study, the prevalence of gestational diabetes mellitus ranged between 9% and 26% across 15 centres.

“According to a global observational study, the prevalence of GDM ranged between 9% and 26% in 15 centres51.”

• cites [51] Sacks, D. A. et al. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. Diabetes Care 35, 526–528 (2012). sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Hypertensive disorders in pregnancy are among the leading causes of maternal and fetal morbidity and mortality worldwide and are responsible for an estimated 14% of maternal deaths globally.

“HDP are among the leading causes of maternal and fetal morbidity and mortality worldwide3, responsible for an estimated 14% of maternal deaths globally.”

• cites [3] Say, L. et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob. Health 2, e323–e333 (2014). sourcePartly supported

  The Results (p. 5) identify hypertensive disorders as the second most common direct cause of maternal death worldwide, accounting for an estimated 14.0% of maternal deaths. The cited passages do not establish the claim about fetal mortality or maternal and fetal morbidity. (LLM, conf=0.88)

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Probably not a substantial claim: may not pass S3 (load-bearing).

Depending on the diagnostic criteria used, 9-25% of pregnancies are affected by gestational diabetes mellitus.

“Depending on the diagnostic criteria used, 9–25% of pregnancies are affected by GDM50.”

• cites [50] Alejandro, E. U. et al. Gestational diabetes mellitus: a harbinger of the vicious cycle of diabetes. Int. J. Mol. Sci. 21, 5003 (2020). sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The Western Pacific region had the lowest prevalence of hypertensive disorders in pregnancy at 16.4 per 100,000 women of childbearing age.

“Conversely, the Western Pacific region had the lowest prevalence of HDP at 16.4 per 100,000 women of childbearing age (Fig. 1).”

• cites [47] Vos, T. et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396, 1204–1222 (2020). sourceCould not verify

  The Methods section describes prevalence estimates across countries and regions, but the passages from our copy do not report a Western Pacific prevalence of hypertensive disorders in pregnancy or rank that region lowest. Searches for the disorder, Western Pacific, and 16.4 found no passage verifying the figure or comparison; page numbers were not available. (LLM, conf=0.74)

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Probably not a substantial claim: may not pass S3 (load-bearing).

Many researchers consider gestational diabetes mellitus treatment highly cost-effective when benefits of future maternal type 2 diabetes mellitus and childhood obesity risk reduction are considered.

“However, many researchers consider GDM treatment highly cost-effective when the benefits of future maternal T2DM and childhood obesity risk reduction are taken into account32,42–45.”

• cites [32] Brown, F. M. & Wyckoff, J. Application of one-step IADPSG versus two-step diagnostic criteria for gestational diabetes in the real world: impact on health services, clinical care, and outcomes. Curr. Diab. Rep. 17, 85 (2017). sourcePartly supported

  The Financial Implications of IADPSG section (page unavailable) reports cost-effective screening and management approaches when future maternal diabetes prevention is considered. It does not link GDM treatment’s cost-effectiveness to reduced childhood obesity risk, and its cost-effectiveness findings concern particular diagnostic approaches rather than GDM treatment generally. (LLM, conf=0.85)

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• cites [42] Moss, J. R., Crowther, C. A., Hiller, J. E., Willson, K. J. & Robinson, J. S. Costs and consequences of treatment for mild gestational diabetes mellitus–evaluation from the ACHOIS randomised trial. BMC Pregnancy Childbirth 7, 27 (2007). sourcePartly supported

  The Conclusion (page not provided) calls the incremental cost per life-year gained highly favourable, based on reductions in perinatal mortality and serious perinatal complications. The Discussion says the evaluation was confined to in-trial costs and consequences, with no modelling beyond the trial. It does not support the claim that the favourable assessment accounts for reduced future maternal type 2 diabetes or childhood obesity risk. (LLM, conf=0.90)

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• cites [43] Ohno, M. S., Sparks, T. N., Cheng, Y. W. & Caughey, A. B. Treating mild gestational diabetes mellitus: a cost-effectiveness analysis. Am. J. Obstet. Gynecol. 205, e281–e287 (2011). sourcePartly supported

  The Results report that treating mild GDM was cost-effective at $20,412 per QALY. But the Comment says the model could not include long-term effects on offspring, including possible obesity, and it does not report a reduction in future maternal type 2 diabetes. Its cost-effectiveness finding therefore was not based on taking those future benefits into account. (LLM, conf=0.88)

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• cites [44] Lowe, W. L. et al. Association of gestational diabetes with maternal disorders of glucose metabolism and childhood adiposity. JAMA 320, 1005–1016 (2018). sourceCould not verify

  The Secondary Outcomes and Gestational Diabetes Status and Outcomes for Children sections report associations between gestational diabetes and later maternal type 2 diabetes and childhood adiposity (page numbers unavailable). Searches for cost-effectiveness, treatment, and prevention found no passage saying that GDM treatment reduces those risks or is considered highly cost-effective. (LLM, conf=0.76)

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• cites [45] Lauring, J. R., Kunselman, A. R., Pauli, J. M., Repke, J. T. & Ural, S. H. Comparison of healthcare utilization and outcomes by gestational diabetes diagnostic criteria. J. Perinat. Med. 46, 401–409 (2018). sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Hypertensive disorders in pregnancy remain one of the most common causes of maternal death worldwide.

“Despite a much lower maternal mortality in HICs than in LMICs, HDP remains one of the most common causes of maternal death worldwide2–4.”

• cites [2] Steegers, E. A., von Dadelszen, P., Duvekot, J. J. & Pijnenborg, R. Pre-eclampsia. Lancet 376, 631–644 (2010). sourceNot checked — no full text of the source
• cites [3] Say, L. et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob. Health 2, e323–e333 (2014). sourceSupported
• cites [4] Duley, L. The global impact of pre-eclampsia and eclampsia. Semin. Perinatol. 33, 130–137 (2009). sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Africa had the highest regional prevalence of hypertensive disorders in pregnancy (mean 334.9 per 100,000 women of childbearing age), followed by Southeast Asia (136.8) and the Middle East (121.4).

“At the regional level, Africa had the highest prevalence of HDP, with a mean prevalence of 334.9 per 100,000 women of childbearing age, followed by Southeast Asia and the Middle East, with mean prevalences of 136.8 and 121.4 per 100,000 women of childbearing age, respectively.”

• cites [47] Vos, T. et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396, 1204–1222 (2020). sourceCould not verify

  The Methods section (Geographical units, age groups, time periods, and cause levels; page not provided) says the study estimated prevalence across regions, but it does not give regional prevalence for hypertensive disorders in pregnancy. Searches for the disorder and the figures 334.9, 136.8, and 121.4 found no passage in our copy supporting the ranking or rates. (LLM, conf=0.76)

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Probably not a substantial claim: may not pass S3 (load-bearing).

Globally, the prevalence of hypertensive disorders in pregnancy is 116.4 per 100,000 women of childbearing age.

“Globally, the prevalence of HDP is 116.4 per 100,000 women of childbearing age.”

• cites [47] Vos, T. et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396, 1204–1222 (2020). sourceCould not verify

  The Methods > Data section says the study uses prevalence data, and Results > Global trends mentions maternal disorders, but neither gives a prevalence rate for hypertensive disorders of pregnancy. Searches for “116.4,” “hypertensive disorders of pregnancy,” and “maternal hypertensive disorders” found no passage substantiating the claimed rate per 100,000 women of childbearing age. Page numbers were not available in our copy. (LLM, conf=0.72)

  Experimental — accuracy not yet measured

May combine two claims.

A low intake of fruit, green leafy vegetables, poultry and fish, and high consumption of a Western dietary pattern might be associated with elevated risk of hypertensive disorders in pregnancy and gestational diabetes mellitus.

“For instance, a low intake of fruit, green leafy vegetables, poultry and fish, and high consumption of the Western dietary pattern (characterized by a high intake of red meat, processed meat, refined grain products, high-fat and/or high-sugar processed food) might be associated with an elevated risk of HDP and GDM78–87 (Fig. 7).”

• cites [78] Bao, W. et al. Prepregnancy low-carbohydrate dietary pattern and risk of gestational diabetes mellitus: a prospective cohort study. Am. J. Clin. Nutr. 99, 1378–1384 (2014). sourceNot checked — no full text of the source
• cites [79] Looman, M. et al. Pre-pregnancy dietary carbohydrate quantity and quality, and risk of developing gestational diabetes: the Australian Longitudinal Study on Women’s Health. Br. J. Nutr. 120, 435–444 (2018). sourcePartly supported

  The Carbohydrate-rich food groups section (page not provided) reports that higher fruit intake was associated with lower GDM risk. The Discussion (page not provided) also links healthier dietary patterns, including fruit and limited refined grains, with lower GDM risk. Our copy does not establish the claimed associations for green leafy vegetables, poultry, fish, or the specified Western dietary pattern, and it does not examine dietary risk of hypertensive disorders of pregnancy. (LLM, conf=0.88)

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• cites [80] Mijatovic-Vukas, J. et al. Associations of diet and physical activity with risk for gestational diabetes mellitus: a systematic review and meta-analysis. Nutrients 10, 698 (2018). sourcePartly supported

  The Results (§3.3.7; page unavailable) report that one study associated a Western diet with higher GDM risk, while another found no such relationship. The Results (§3.3.1) also report a protective association for fruit fiber, and the Discussion (§4.1) links higher red or processed meat intake to GDM risk. This review does not establish the claimed associations for low green leafy vegetable, poultry, or fish intake, or address hypertensive disorders in pregnancy as an outcome. (LLM, conf=0.88)

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• cites [81] O’Malley, E. G. et al. Maternal obesity and dyslipidemia associated with gestational diabetes mellitus (GDM). Eur. J. Obstet. Gynecol. Reprod. Biol. 246, 67–71 (2020). sourceNot checked — no full text of the source
• cites [82] Shin, D., Lee, K. W. & Song, W. O. Dietary patterns during pregnancy are associated with risk of gestational diabetes mellitus. Nutrients 7, 9369–9382 (2015). sourcePartly supported

  The Results and Conclusions report that patterns low in fruits, vegetables and seafood and high in refined grains, fats or added sugars were associated with increased GDM risk. The Discussion also describes an association between a Western dietary pattern and GDM. The paper does not establish the claimed association with hypertensive disorders of pregnancy, nor does it identify low poultry intake specifically as a risk factor. (LLM, conf=0.87)

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• cites [83] Schoenaker, D. A., Soedamah-Muthu, S. S., Callaway, L. K. & Mishra, G. D. Prepregnancy dietary patterns and risk of developing hypertensive disorders of pregnancy: results from the Australian Longitudinal Study on Women’s Health. Am. J. Clin. Nutr. 102, 94–101 (2015). sourcePartly supported

  The Results section (page unavailable) reports lower HDP risk with a Mediterranean-style pattern that includes vegetables and fish. But the Discussion (page unavailable) reports no HDP association for the meat, high-fat, and sugar pattern or the fruit and low-fat dairy pattern. The paper treats GDM as an adjustment factor, not an outcome, and does not establish the claimed risks for low poultry intake or the specified Western pattern. (LLM, conf=0.88)

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• cites [84] Sahariah, S. A. et al. A daily snack containing leafy green vegetables, fruit, and milk before and during pregnancy prevents gestational diabetes in a randomized, controlled trial in Mumbai, India. J. Nutr. 146, 1453s–1460s (2016). sourcePartly supported

  The Introduction (page not available) reports observational associations between lower GDM prevalence and higher intakes of fruit, vegetables, poultry, and fish, alongside lower intakes of foods characteristic of the described Western pattern. The Discussion (page not available) also reports lower GDM risk with a diet rich in fruit, green leafy vegetables, poultry, and fish. Our copy does not link these dietary patterns to hypertensive disorders in pregnancy. (LLM, conf=0.87)

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• cites [85] Schoenaker, D. A., Mishra, G. D., Callaway, L. K. & Soedamah-Muthu, S. S. The role of energy, nutrients, foods, and dietary patterns in the development of gestational diabetes mellitus: a systematic review of observational studies. Diabetes Care 39, 16–23 (2016). sourceNot checked — no full text of the source
• cites [86] Kinshella, M. W. et al. Maternal dietary patterns and pregnancy hypertension in low- and middle-income countries: a systematic review and meta-analysis. Adv. Nutr. 12, 2387–2400 (2021). sourcePartly supported

  The Discussion reports that low fruit and vegetable intake was associated with higher odds of pre-eclampsia, and says limited evidence suggests a possible association with Western-style diets. The Other dietary patterns section reports no association for poultry or fish in the study it discusses. The paper addresses pregnancy hypertension, not gestational diabetes mellitus, so it does not support the GDM portion of the claim. (LLM, conf=0.88)

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• cites [87] Dolatkhah, N., Hajifaraji, M. & Shakouri, S. K. Nutrition therapy in managing pregnant women with gestational diabetes mellitus: a literature review. J. Fam. Reprod. Health 12, 57–72 (2018).Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Screening and diagnostic approaches for gestational diabetes mellitus are under debate due to differences in guideline focus.

“Currently, the screening and diagnostic approaches for GDM are under debate24–32 given differences in the focus of different guidelines.”

• cites [24] O’Sullivan, E. P. et al. Atlantic Diabetes in Pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria. Diabetologia 54, 1670–1675 (2011). sourcePartly supported

  The Introduction (page not provided) says screening practices vary across Irish centres, and the Diagnostic criteria section compares WHO, IADPSG and ADA criteria. These passages support differences in screening and diagnosis, but do not say the approaches are under debate because guidelines differ in focus. (LLM, conf=0.82)

  Experimental — accuracy not yet measured
• cites [25] Bodmer-Roy, S., Morin, L., Cousineau, J. & Rey, E. Pregnancy outcomes in women with and without gestational diabetes mellitus according to the International Association of the Diabetes and Pregnancy Study Groups criteria. Obstet. Gynecol. 120, 746–752 (2012). sourceNot checked — no full text of the source
• cites [26] Mayo, K., Melamed, N., Vandenberghe, H. & Berger, H. The impact of adoption of the International Association of Diabetes in Pregnancy Study Group criteria or the screening and diagnosis of gestational diabetes. Am. J. Obstet. Gynecol. 212, e221–e229 (2015). sourceNot checked — no full text of the source
• cites [27] Trujillo, J. et al. Impact of the International Association of Diabetes and Pregnancy Study Groups criteria for gestational diabetes. Diabetes Res. Clin. Pract. 108, 288–295 (2015). sourceNot checked — no full text of the source
• cites [28] Ramezani Tehrani, F., Naz, M. S. G., Yarandi, R. B. & Behboudi-Gandevani, S. The impact of diagnostic criteria for gestational diabetes mellitus on adverse maternal outcomes: a systematic review and meta-analysis. J. Clin. Med. 10, 666 (2021). sourceSupported
• cites [29] Hartling, L. et al. Diagnostic thresholds for gestational diabetes and their impact on pregnancy outcomes: a systematic review. Diabet. Med. 31, 319–331 (2014). sourceNot checked — no full text of the source
• cites [30] Feldman, R. K., Tieu, R. S. & Yasumura, L. Gestational diabetes screening: the International Association of the Diabetes and Pregnancy Study Groups compared with Carpenter–Coustan screening. Obstet. Gynecol. 127, 10–17 (2016). sourceNot checked — no full text of the source
• cites [31] Saccone, G., Khalifeh, A., Al-Kouatly, H. B., Sendek, K. & Berghella, V. Screening for gestational diabetes mellitus: one step versus two step approach. A meta-analysis of randomized trials. J. Matern. Fetal Neonatal Med. 33, 1616–1624 (2020). sourceNot checked — no full text of the source
• cites [32] Brown, F. M. & Wyckoff, J. Application of one-step IADPSG versus two-step diagnostic criteria for gestational diabetes in the real world: impact on health services, clinical care, and outcomes. Curr. Diab. Rep. 17, 85 (2017). sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Social stress, malnutrition during pregnancy and environmental toxins have been proposed as three social determinants of health factors that might affect placental health.

“For example, social stress, malnutrition during pregnancy and environmental toxins have been proposed as three SDOH factors that might affect placental health141.”

• cites [141] Thornburg, K. L., Boone-Heinonen, J. & Valent, A. M. Social determinants of placental health and future disease risks for babies. Obstet. Gynecol. Clin. North. Am. 47, 1–15 (2020). sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Many population studies found more genetic variations within racial groups than among them.

“For example, many population studies found more genetic variations within racial groups than among them137,138.”

• cites [137] Mohsen, H. Race and genetics: somber history, troubled present. Yale J. Biol. Med. 93, 215–219 (2020).Not checked — no full text of the source
• cites [138] Maglo, K. N., Mersha, T. B. & Martin, L. J. Population genomics and the statistical values of race: an interdisciplinary perspective on the biological classification of human populations and implications for clinical genetic epidemiological research. Front. Genet. 7, 22 (2016). sourceSupported

May combine two claims.

Higher socioeconomic status reduced the risk of hypertensive disorders in pregnancy in white pregnant individuals and indirectly predicted longer gestation length.

“Higher socioeconomic status (SES), whether indicated by education or insurance status, further reduced the risk of HDP in white pregnant individuals, which in turn indirectly predicted longer gestation length.”

• cites [142] Silva, L. M. et al. Low socioeconomic status is a risk factor for preeclampsia: the Generation R Study. J. Hypertens. 26, 1200–1208 (2008). sourceNot checked — no full text of the source
• cites [143] Silva, L. et al. Maternal educational level and risk of gestational hypertension: the Generation R Study. J. Hum. Hypertens. 22, 483–492 (2008). sourcePartly supported

  The Results (p. 2) associate lower maternal education with higher gestational-hypertension risk, supporting the education-based SES comparison. The Study population (p. 3) is defined by Dutch parental birthplace, not by white racial identity, and excludes other hypertensive disorders. The paper does not examine insurance status or test whether reduced hypertension indirectly predicts longer gestation; the Results (p. 5) report gestational age only descriptively. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Potential risk factors for gestational diabetes mellitus include carrying a male fetus, parity and polycystic ovarian syndrome, although some evidence is inconsistent.

“Other potential risk factors include carrying a male fetus103–106, parity7 and polycystic ovarian syndrome107, although some evidence is not very consistent108.”

• cites [103] Retnakaran, R. et al. Fetal sex and maternal risk of gestational diabetes mellitus: the impact of having a boy. Diabetes Care 38, 844–851 (2015). sourceNot checked — no full text of the source
• cites [104] Yamashita, H. et al. Fetal sex and maternal insulin resistance during mid-pregnancy: a retrospective cohort study. BMC Pregnancy Childbirth 20, 560 (2020). sourceSupported
• cites [105] Retnakaran, R. & Shah, B. R. Fetal sex and the natural history of maternal risk of diabetes during and after pregnancy. J. Clin. Endocrinol. Metab. 100, 2574–2580 (2015). sourceNot checked — no full text of the source
• cites [106] Jaskolka, D., Retnakaran, R., Zinman, B. & Kramer, C. K. Sex of the baby and risk of gestational diabetes mellitus in the mother: a systematic review and meta-analysis. Diabetologia 58, 2469–2475 (2015). sourceSupported
• cites [7] Zhu, Y. & Zhang, C. Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global perspective. Curr. Diab. Rep. 16, 7 (2016). sourceSupported
• cites [107] Lo, J. C. et al. Increased prevalence of gestational diabetes mellitus among women with diagnosed polycystic ovary syndrome: a population-based study. Diabetes Care 29, 1915–1917 (2006). sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The risk of hypertensive disorders in pregnancy in Pacific Islander populations is still controversial.

“whereas the risk of HDP in Pacific Islander populations is still controversial118,119.”

• cites [118] Ghosh, G. et al. Racial/ethnic differences in pregnancy-related hypertensive disease in nulliparous women. Ethn. Dis. 24, 283–289 (2014).Not checked — no full text of the source
• cites [119] Chang, A. L., Hurwitz, E., Miyamura, J., Kaneshiro, B. & Sentell, T. Maternal risk factors and perinatal outcomes among Pacific Islander groups in Hawaii: a retrospective cohort study using statewide hospital data. BMC Pregnancy Childbirth 15, 239 (2015). sourcePartly supported

  The Background (page unavailable) says evidence on preeclampsia in Pacific Islander groups is extremely limited, and the Discussion calls for further study of differing hypertension rates. The Results (page unavailable) report higher adjusted odds of hypertension than in White women for all studied Pacific Islander subgroups except Micronesians. These passages support uncertainty and subgroup differences, but do not establish that the risk is controversial. (LLM, conf=0.78)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Circulating levels of placental growth factor in Black women and South and East Asian women are higher than in white women.

“For instance, circulating levels of placental growth factor (PlGF) in Black women and South and East Asian women are higher than in white women130.”

• cites [130] Yang, J. et al. Racial-ethnic differences in midtrimester maternal serum levels of angiogenic and antiangiogenic factors. Am. J. Obstet. Gynecol. 215, 359.e1–359.e9 (2016). sourcePartly supported

  The Results report higher midtrimester PlGF levels in Black women than in White women, in both cases and controls. The study compares Black, White, and Hispanic women; it does not support the claim about South or East Asian women. Page numbers were not available in our copy. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

May combine two claims.

A previous history of gestational diabetes mellitus and a family history of diabetes mellitus might increase the risk of developing gestational diabetes mellitus in a current pregnancy.

“In terms of GDM, a previous history of GDM and a family history of diabetes mellitus might increase the risk of developing GDM in a current pregnancy63.”

• cites [63] Lee, K. W. et al. Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. BMC Pregnancy Childbirth 18, 494 (2018). sourceSupported

May combine two claims.

Other risk factors for hypertensive disorders in pregnancy include previous history of hypertensive disorders in pregnancy, family history of hypertensive disorders in pregnancy and pre-existing diseases such as chronic hypertension, pregestational diabetes mellitus, thrombophilia, systemic lupus erythematosus, antiphospholipid antibody syndrome, kidney disease and obstructive sleep apnoea.

“Other risk factors for HDP include a previous history of HDP93,98,99, a family history of HDP93 and pre-existing diseases, such as chronic hypertension, pregestational diabetes mellitus, thrombophilia, systemic lupus erythematosus, antiphospholipid antibody syndrome, kidney disease and obstructive sleep apnoea16,93,94,97.”

• cites [93] Duckitt, K. & Harrington, D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ 330, 565 (2005). sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured
• cites [98] Zhang, J., Troendle, J. F. & Levine, R. J. Risks of hypertensive disorders in the second pregnancy. Paediatr. Perinat. Epidemiol. 15, 226–231 (2001). sourceNot checked — no full text of the source
• cites [99] Boghossian, N. S., Albert, P. S., Mendola, P., Grantz, K. L. & Yeung, E. Delivery blood pressure and other first pregnancy risk factors in relation to hypertensive disorders in second pregnancies. Am. J. Hypertens. 28, 1172–1179 (2015). sourcePartly supported

  The Results (page unavailable) document recurrence of hypertensive disorders in second pregnancies and report that women with preexisting diabetes mellitus were more likely to develop one. The Discussion (page unavailable) says the study lacked family-history data. The cited paper does not establish the remaining listed diseases as risk factors; it treats chronic hypertension chiefly as an outcome and excludes women with a history of it from further analyses. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [16] The American College of Obstetricians and Gynecologists. Gestational hypertension and preeclampsia: ACOG practice bulletin, number 222. Obstet. Gynecol. 135, e237–e260 (2020). sourceNot checked — no full text of the source
• cites [94] Bartsch, E., Medcalf, K. E., Park, A. L. & Ray, J. G. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ 353, i1753 (2016). sourcePartly supported

  The Methods (Selection of studies; page unavailable) list prior pre-eclampsia, chronic hypertension, pregestational diabetes, chronic kidney disease, systemic lupus erythematosus and antiphospholipid antibody syndrome as risk factors assessed; the Results report elevated pre-eclampsia risk for the assessed factors. The paper explicitly says it did not assess family history, and these passages do not support thrombophilia or obstructive sleep apnoea. Its findings concern pre-eclampsia specifically, rather than hypertensive disorders of pregnancy as a whole. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [97] Leon, L. J. et al. Preeclampsia and cardiovascular disease in a large UK pregnancy cohort of linked electronic health records. Circulation 140, 1050–1060 (2019). sourcePartly supported

  The Discussion identifies high blood pressure, including pre-pregnancy hypertension, as a risk factor for HDP and preeclampsia. Our copy does not identify the other listed pre-existing diseases as HDP risk factors. The study primarily examines cardiovascular outcomes after HDP, rather than the full set of proposed antecedent risk factors. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

Obstetric complications and situations including primiparity, multifetal pregnancy and history of gestational diabetes mellitus are related to the development of hypertensive disorders in pregnancy.

“Some obstetric complications and situations, including primiparity56,58,88–91, multifetal pregnancy56–58,88,91 and history of GDM56,91,92, are related to the development of HDP16,56,65,66,88,90,91,93–97.”

• cites [56] Ye, C. et al. The 2011 survey on hypertensive disorders of pregnancy (HDP) in China: prevalence, risk factors, complications, pregnancy and perinatal outcomes. PLoS ONE 9, e100180 (2014). sourcePartly supported

  The Abstract identifies primiparity and twin pregnancy as HDP risk factors, and the Discussion reports higher HDP prevalence in twin than singleton pregnancies. The Discussion also identifies GDM as a risk factor, but the paper’s Methods and Results address GDM during the studied pregnancy, not a history of GDM in a previous pregnancy. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [58] Abalos, E. et al. Pre-eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization multicountry survey on maternal and newborn health. BJOG 121, s14–s24 (2014). sourceNot checked — no full text of the source
• cites [88] Lee, C. J. et al. Risk factors for pre-eclampsia in an Asian population. Int. J. Gynaecol. Obstet. 70, 327–333 (2000). sourceNot checked — no full text of the source
• cites [89] Coonrod, D. V., Hickok, D. E., Zhu, K., Easterling, T. R. & Daling, J. R. Risk factors for preeclampsia in twin pregnancies: a population-based cohort study. Obstet. Gynecol. 85, 645–650 (1995). sourceNot checked — no full text of the source
• cites [90] Eskenazi, B., Fenster, L. & Sidney, S. A multivariate analysis of risk factors for preeclampsia. JAMA 266, 237–241 (1991). sourceNot checked — no full text of the source
• cites [91] Conde-Agudelo, A. & Belizán, J. M. Risk factors for pre-eclampsia in a large cohort of Latin American and Caribbean women. BJOG 107, 75–83 (2000). sourceNot checked — no full text of the source
• cites [57] Ma, R. et al. Study on the descriptive epidemiology of pregnancy-induced hypertension from 1995–2000 in Jiaxing of Zhejiang province, China [Chinese]. Zhonghua Liu Xing Bing Xue Za Zhi 26, 960–963 (2005).Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [92] Ros, H. S., Cnattingius, S. & Lipworth, L. Comparison of risk factors for preeclampsia and gestational hypertension in a population-based cohort study. Am. J. Epidemiol. 147, 1062–1070 (1998). sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Race can be considered a social construct rather than a biological construct, as it is a socially derived label that may not justify biological or genetic differences between populations.

“Of note, race can be considered as a social construct rather than a biological construct114,134, as race is a socially derived label that can either be self-reported or assigned and might not justify any biological or genetic differences between populations135,136.”

• cites [114] Johnson, J. D. & Louis, J. M. Does race or ethnicity play a role in the origin, pathophysiology, and outcomes of preeclampsia? An expert review of the literature. Am. J. Obstet. Gynecol. 226, S876–S885 (2022). sourceNot checked — no full text of the source
• cites [134] Ford, M. E. & Kelly, P. A. Conceptualizing and categorizing race and ethnicity in health services research. Health Serv. Res. 40, 1658–1675 (2005). sourceSupported
• cites [135] White, K., Lawrence, J. A., Tchangalova, N., Huang, S. J. & Cummings, J. L. Socially-assigned race and health: a scoping review with global implications for population health equity. Int. J. Equity Health 19, 25 (2020). sourcePartly supported

  The Introduction (page unavailable) describes race as socially constructed and explains that it may be self-identified or assigned by others. The cited paper does not address whether racial labels justify biological or genetic differences between populations, so that part of the attributed claim is unsupported. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [136] Mersha, T. B. & Abebe, T. Self-reported race/ethnicity in the age of genomic research: its potential impact on understanding health disparities. Hum. Genomics 9, 1 (2015). sourceSupported

May combine two claims.

Nitrogen dioxide, PM2.5 and traffic exposure are suggested to be associated with pre-eclampsia.

“nitrogen dioxide, PM2.5 and traffic exposure were suggested to be associated with pre-eclampsia.”

• cites [169] Rosen, E. M., Muñoz, M. I., McElrath, T., Cantonwine, D. E. & Ferguson, K. K. Environmental contaminants and preeclampsia: a systematic literature review. J. Toxicol. Env. Health B Crit. Rev. 21, 291–319 (2018). sourceSupported

May combine two claims.

Maternal CMDs can cause a range of negative perinatal outcomes for mother and baby, including organ injury, death, growth abnormalities, birth trauma, metabolic and respiratory problems, congenital malformations, stillbirth and neonatal death.

“Furthermore, they can have negative perinatal outcomes for both the mother and the fetus or neonate, such as maternal end-organ injuries, maternal death, IUGR, large for gestational age, shoulder dystocia, hypoglycaemia, birth asphyxia, respiratory distress syndrome33,171,172, congenital malformations in neonates173,174, stillbirth and neonatal death.”

• cites [33] Metzger, B. E. et al. Hyperglycemia and adverse pregnancy outcomes. N. Engl. J. Med. 358, 1991–2002 (2008). sourceNot checked — no full text of the source
• cites [171] Wong, T., Ross, G. P., Jalaludin, B. B. & Flack, J. R. The clinical significance of overt diabetes in pregnancy. Diabet. Med. 30, 468–474 (2013). sourceNot checked — no full text of the source
• cites [172] Szmuilowicz, E. D., Josefson, J. L. & Metzger, B. E. Gestational diabetes mellitus. Endocrinol. Metab. Clin. North. Am. 48, 479–493 (2019). sourcePartly supported

  The Offspring Outcomes > Neonatal Complications section (page unavailable) describes large-for-gestational-age birth, shoulder dystocia, neonatal hypoglycemia, birth asphyxia, respiratory distress syndrome, and possible stillbirth in pregnancies affected by diabetes. It does not support the attributed maternal end-organ injury, maternal death, IUGR, or neonatal death outcomes, and its discussion is chiefly about gestational diabetes rather than maternal CMDs broadly. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [173] Bellizzi, S. et al. Are hypertensive disorders in pregnancy associated with congenital malformations in offspring? Evidence from the WHO multicountry cross sectional survey on maternal and newborn health. BMC Pregnancy Childbirth 16, 198 (2016). sourceSupported
• cites [174] Wu, Y. et al. Association of maternal prepregnancy diabetes and gestational diabetes mellitus with congenital anomalies of the newborn. Diabetes Care 43, 2983–2990 (2020). sourceSupported

May combine two claims.

High socioeconomic status is not as health-protective for Black individuals, which might be explained by structural and cultural forms of racism they experience despite their socioeconomic status.

“High SES is not as health-protective for Black individuals, which might be explained by structural and cultural forms of racism they experience despite their SES144.”

• cites [144] Ross, K. M. et al. Socioeconomic status, preeclampsia risk and gestational length in black and white women. J. Racial Ethn. Health Disparities 6, 1182–1191 (2019). sourceSupported

May combine two claims.

Socioeconomic status factors such as education, occupation and household income have been reported to be associated with gestational diabetes mellitus, but study findings are inconsistent.

“SES factors, such as education, occupation and household income, have been reported to be associated with GDM152, but study findings are inconsistent6,143,153–157.”

• cites [152] Dode, M. A. & dos Santos, I. S. Non classical risk factors for gestational diabetes mellitus: a systematic review of the literature. Cad. Saude Publica 25, S341–S359 (2009). sourcePartly supported

  The Socioeconomic level/education section reports associations of GDM with maternal education and occupational categories, and the Conclusions describe the socioeconomic findings as controversial. But the review reports no association with average household income in the study it discusses, so it does not support household income as an associated factor. In the printed sentence, the inconsistency clause has separate citations. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [6] Anna, V., van der Ploeg, H. P., Cheung, N. W., Huxley, R. R. & Bauman, A. E. Sociodemographic correlates of the increasing trend in prevalence of gestational diabetes mellitus in a large population of women between 1995 and 2005. Diabetes Care 31, 2288–2293 (2008). sourcePartly supported

  The Conclusions report an inverse association between socioeconomic status and GDM and describe conflicting findings in earlier studies. They mention education and current employment as associated factors, but do not establish an association for occupation; they list income among factors in a study reporting no association. This paper measured socioeconomic status by postcode rather than those individual factors. (LLM, conf=0.83)

  Experimental — accuracy not yet measured
• cites [143] Silva, L. et al. Maternal educational level and risk of gestational hypertension: the Generation R Study. J. Hum. Hypertens. 22, 483–492 (2008). sourceCould not verify

  The Introduction (p. 2) and Comparison with other studies (p. 8) discuss inconsistent findings about socioeconomic status and gestational hypertension or pre-eclampsia, not gestational diabetes mellitus (GDM). A search for gestational diabetes found no passage in our copy addressing whether education, occupation or household income is associated with GDM. (LLM, conf=0.75)

  Experimental — accuracy not yet measured
• cites [153] Bo, S. et al. Low socioeconomic status as a risk factor for gestational diabetes. Diabetes Metab. 28, 139–140 (2002).Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [154] Bouthoorn, S. H. et al. Low-educated women have an increased risk of gestational diabetes mellitus: the Generation R Study. Acta Diabetol. 52, 445–452 (2015). sourceNot checked — no full text of the source
• cites [155] Song, L. et al. Socio-economic status and risk of gestational diabetes mellitus among Chinese women. Diabet. Med. 34, 1421–1427 (2017). sourceNot checked — no full text of the source
• cites [156] Carroll, X. et al. Socioeconomic, environmental and lifestyle factors associated with gestational diabetes mellitus: a matched case-control study in Beijing, China. Sci. Rep. 8, 8103 (2018). sourceSupported
• cites [157] Liu, J. et al. Indicators of socio-economic status and risk of gestational diabetes mellitus in pregnant women in urban Tianjin, China. Diabetes Res. Clin. Pract. 144, 192–199 (2018). sourceNot checked — no full text of the source

May combine two claims.

Women with a history of HDP have a higher risk of developing hypertension, CVD and CVD-related morbidity and mortality than women with uncomplicated pregnancies.

“Moreover, women with a history of HDP are at a higher risk of developing hypertension, CVD and CVD-related morbidity and mortality than women with uncomplicated pregnancies97,177–188”

• cites [97] Leon, L. J. et al. Preeclampsia and cardiovascular disease in a large UK pregnancy cohort of linked electronic health records. Circulation 140, 1050–1060 (2019). sourceSupported
• cites [177] Wu, R. et al. Hypertensive disorders of pregnancy and risk of cardiovascular disease-related morbidity and mortality: a systematic review and meta-analysis. Cardiology 145, 633–647 (2020). sourceNot checked — no full text of the source
• cites [178] Melchiorre, K. et al. Hypertensive disorders of pregnancy and future cardiovascular health. Front. Cardiovasc. Med. 7, 59 (2020). sourceSupported
• cites [179] Bellamy, L., Casas, J. P., Hingorani, A. D. & Williams, D. J. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ 335, 974 (2007). sourcePartly supported

  The Results report higher later hypertension, cardiovascular disease, and fatal cardiovascular-event risks after pre-eclampsia; the Discussion also reports higher future hypertension and cardiovascular disease risk after pregnancy-induced hypertension. The claim extends these findings to all hypertensive disorders of pregnancy (HDP), whereas the Methods specify pre-eclampsia and a separate analysis of pregnancy-induced hypertension, with comparison groups defined by absence of pre-eclampsia rather than uncomplicated pregnancy. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [180] Wilson, B. J. et al. Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life: results from cohort study. BMJ 326, 845 (2003). sourcePartly supported

  The Questionnaire assessed outcomes and Hospital admissions sections report more later hypertension and some circulatory-disease admissions among women with gestational hypertension or pre-eclampsia/eclampsia than among controls. The Discussion reports increased stroke admissions and stroke mortality, but explicitly says there was no significant increase in coronary heart disease morbidity or mortality. The claim overgeneralizes those findings to CVD-related morbidity and mortality as a whole. Page numbers are not available in our copy. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [181] Stuart, J. J. et al. Hypertensive disorders of pregnancy and 10-year cardiovascular risk prediction. J. Am. Coll. Cardiol. 72, 1252–1263 (2018). sourcePartly supported

  The Introduction (page unavailable) states that women with HDP have a two-fold increased risk of CVD, and the Results compare CVD rates after HDP with rates after normotensive pregnancies. The Methods include fatal and nonfatal events in the CVD outcome. The paper does not establish a separate higher risk of developing hypertension or a separate increase in CVD-related mortality; the Discussion mentions chronic hypertension as a mediator of CVD risk. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [182] Veerbeek, J. H. et al. Cardiovascular disease risk factors after early-onset preeclampsia, late-onset preeclampsia, and pregnancy-induced hypertension. Hypertension 65, 600–606 (2015). sourceNot checked — no full text of the source
• cites [183] McDonald, S. D., Malinowski, A., Zhou, Q., Yusuf, S. & Devereaux, P. J. Cardiovascular sequelae of preeclampsia/eclampsia: a systematic review and meta-analyses. Am. Heart J. 156, 918–930 (2008). sourceNot checked — no full text of the source
• cites [184] Brown, M. C. et al. Cardiovascular disease risk in women with pre-eclampsia: systematic review and meta-analysis. Eur. J. Epidemiol. 28, 1–19 (2013). sourceNot checked — no full text of the source
• cites [185] Wu, P. et al. Preeclampsia and future cardiovascular health: a systematic review and meta-analysis. Circ. Cardiovasc. Qual. Outcomes 10, e003497 (2017). sourcePartly supported

  The Discussion reports that women with a history of preeclampsia had higher risks of future cardiovascular disease and coronary heart disease death than women without that history; it also identifies preeclampsia as a risk factor for future hypertension. The claim extends those findings to all hypertensive disorders of pregnancy (HDP), whereas this review focuses on preeclampsia and notes that pregnancy-induced hypertension may have distinct cardiovascular consequences. Page numbers were not available in our copy. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

May combine two claims.

A prospective study demonstrated a modest association between depressive symptoms early in pregnancy and an increased risk of incident gestational diabetes mellitus, particularly in women without obesity and women with persistent depressive symptoms throughout the first two trimesters.

“A prospective study demonstrated a modest association between depressive symptoms early in pregnancy and an increased risk of incident GDM, particularly in women without obesity and women with persistent depressive symptoms throughout the first two trimesters of pregnancy160.”

• cites [160] Hinkle, S. N. et al. A longitudinal study of depression and gestational diabetes in pregnancy and the postpartum period. Diabetologia 59, 2594–2602 (2016). sourceSupported

May combine two claims.

Obesity and certain dietary patterns such as the Western dietary pattern are risk factors for hypertension and hyperglycaemia in pregnancy.

“Obesity56,65–67 and certain dietary patterns such as the Western dietary pattern85 are risk factors for hypertension and hyperglycaemia in pregnancy.”

• cites [56] Ye, C. et al. The 2011 survey on hypertensive disorders of pregnancy (HDP) in China: prevalence, risk factors, complications, pregnancy and perinatal outcomes. PLoS ONE 9, e100180 (2014). sourcePartly supported

  The Discussion (page unavailable) says obese women had the highest risk of hypertensive disorders of pregnancy, supporting the obesity–hypertension portion of the claim. It does not establish obesity as a risk factor for hyperglycaemia; it instead discusses gestational diabetes as a risk factor for hypertensive disorders. The Western dietary pattern has a separate citation in the citing sentence and is not attributed to this paper. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [65] Meazaw, M. W., Chojenta, C., Muluneh, M. D. & Loxton, D. Systematic and meta-analysis of factors associated with preeclampsia and eclampsia in sub-Saharan Africa. PLoS ONE 15, e0237600 (2020). sourcePartly supported

  The Results section (Risk factors for preeclampsia/eclampsia; page unavailable) reports that higher BMI was associated with greater risk of preeclampsia/eclampsia, supporting the obesity part for that hypertensive pregnancy condition. It does not show that obesity raises the risk of hyperglycaemia in pregnancy. The Western dietary pattern has a separate citation in the citing sentence and is not attributed to this source. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [66] Bilano, V. L., Ota, E., Ganchimeg, T., Mori, R. & Souza, J. P. Risk factors of pre-eclampsia/eclampsia and its adverse outcomes in low- and middle-income countries: a WHO secondary analysis. PLoS ONE 9, e91198 (2014). sourcePartly supported

  The Results report that high maternal BMI was associated with higher odds of pre-eclampsia/eclampsia, a pregnancy-related hypertensive condition. The paper does not establish obesity as a risk factor for hyperglycaemia in pregnancy; it instead examines gestational diabetes as a risk factor for pre-eclampsia/eclampsia. The Western dietary pattern has a separate citation in the citing sentence. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [67] Wang, Z. et al. Maternal adiposity as an independent risk factor for pre-eclampsia: a meta-analysis of prospective cohort studies. Obes. Rev. 14, 508–521 (2013). sourceNot checked — no full text of the source
• cites [85] Schoenaker, D. A., Mishra, G. D., Callaway, L. K. & Soedamah-Muthu, S. S. The role of energy, nutrients, foods, and dietary patterns in the development of gestational diabetes mellitus: a systematic review of observational studies. Diabetes Care 39, 16–23 (2016). sourceNot checked — no full text of the source

May combine two claims.

A package of care for GDM is effective in reducing the risk of most adverse perinatal outcomes, but the evidence is of low quality.

“A package of care (a combination of treatments starting with dietary modifications and/or exercise and/or pharmacological treatments) is effective in reducing the risk of most adverse perinatal outcomes of GDM, but the evidence is of low quality245.”

• cites [245] Farrar, D. et al. Treatments for gestational diabetes: a systematic review and meta-analysis. BMJ Open 7, e015557 (2017). sourceSupported

May combine two claims.

Calcium insufficiency and extremely young maternal age are recognized risk factors for HDP.

“Calcium insufficiency71, and extremely young maternal age55,56,58 are also recognized risk factors for HDP.”

• cites [71] Hofmeyr, G. J., Lawrie, T. A., Atallah, Á. N. & Torloni, M. R. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst. Rev. 10, CD001059 (2018).Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [55] Ananth, C. V., Keyes, K. M. & Wapner, R. J. Pre-eclampsia rates in the United States, 1980–2010: age-period-cohort analysis. BMJ 347, f6564 (2013). sourcePartly supported

  The Results (Age-period-cohort effects on pre-eclampsia; page unavailable) report the highest pre-eclampsia risk at the extremes of maternal age, supporting the young-age portion attributed to this paper. The study addresses pre-eclampsia, not hypertensive disorders of pregnancy (HDP) as a whole. Calcium insufficiency has a separate citation in the citing sentence and is not attributed to this source. (LLM, conf=0.80)

  Experimental — accuracy not yet measured
• cites [56] Ye, C. et al. The 2011 survey on hypertensive disorders of pregnancy (HDP) in China: prevalence, risk factors, complications, pregnancy and perinatal outcomes. PLoS ONE 9, e100180 (2014). sourcePartly supported

  The citation to this paper is attached to extremely young maternal age, not calcium insufficiency. Table 1 in the Results shows a slightly higher HDP prevalence among women under 20 (5.10%) than among those aged 25–29 (4.33%), but the paper does not identify extremely young age as a risk factor; its risk-factor analysis and Discussion emphasize increased risk at older ages. No page numbers are available in our copy. (LLM, conf=0.78)

  Experimental — accuracy not yet measured
• cites [58] Abalos, E. et al. Pre-eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization multicountry survey on maternal and newborn health. BJOG 121, s14–s24 (2014). sourceNot checked — no full text of the source

May combine two claims.

A 2021 systematic review found an increased risk of ASD but not ADHD in offspring exposed to GDM.

“A 2021 systematic review found an increased risk of developing ASD but not ADHD in offspring when exposed to GDM221.”

• cites [221] Rowland, J. & Wilson, C. A. The association between gestational diabetes and ASD and ADHD: a systematic review and meta-analysis. Sci. Rep. 11, 5136 (2021). sourceSupported

May combine two claims.

An overview of Cochrane reviews found effects for preventing GDM only for combined diet and exercise during pregnancy and supplementation with myo-inositol, vitamin D and metformin, with low to moderate quality evidence.

“The researchers found effects only for combined diet and exercise interventions during pregnancy and supplementation with myo-inositol, vitamin D and treatment with metformin, but the evidence was of low to moderate quality.”

• cites [247] Griffith, R. J. et al. Interventions to prevent women from developing gestational diabetes mellitus: an overview of Cochrane reviews. Cochrane Database Syst. Rev. 6, CD012394 (2020). sourceSupported

May combine two claims.

The CLIP trials suggest community-level interventions for women with HDP can be successfully completed by community health workers, but their numbers must be adequate to provide at least eight antenatal care contacts to reduce adverse outcomes.

“The findings from the CLIP trials suggest that community-level interventions for women with HDP can be successfully completed by community health workers, but their numbers must be adequate to provide at least eight antenatal care contacts to reduce adverse outcomes259.”

• cites [259] von Dadelszen, P. et al. The Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials in Mozambique, Pakistan, and India: an individual participant-level meta-analysis. Lancet 396, 553–563 (2020). sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

May combine two claims.

A prospective observational study in Nepal found that during COVID-19 lockdowns, institutional childbirth was reduced by more than half, with increased institutional stillbirth rate and neonatal mortality and decreased quality of care.

“The study found that institutional childbirth was reduced by more than half during lockdowns, along with an increase in the institutional stillbirth rate and neonatal mortality and decreased quality of care.”

• cites [263] Kc, A. et al. Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study. Lancet Glob. Health 8, e1273–e1281 (2020). sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The Western Pacific had the lowest prevalence of gestational diabetes mellitus, with a median of 14.0%.

“With a median prevalence of 14.0%, the Western Pacific had the lowest prevalence of GDM.”

• cites [53] International Diabetes Federation. IDF Diabetes Atlas 10th edn (IDF, 2021).Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Southeast Asia had the highest prevalence of gestational diabetes mellitus (median 25.9%), followed by the North American and Caribbean regions (median 20.7%).

“Southeast Asia had the highest prevalence of GDM, with a median estimate of 25.9%, followed by the North American and Caribbean regions (median prevalence 20.7%).”

• cites [53] International Diabetes Federation. IDF Diabetes Atlas 10th edn (IDF, 2021).Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Adopting broad definitions of gestational diabetes mellitus might increase health-care costs.

“with potentially increased health-care costs40”

• cites [40] Gillespie, P., O’Neill, C., Avalos, G. & Dunne, F. P. New estimates of the costs of universal screening for gestational diabetes mellitus in Ireland. Ir. Med. J. 105, s15–s18 (2012).Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The proportion of maternal deaths attributable to hypertensive disorders in pregnancy is 7.4% in the USA, accounting for an estimated one-fifth of antenatal admissions and two-thirds of referrals to daytime assessment units.

“The proportion of maternal deaths attributable to HDP is 7.4% in the USA, accounting for an estimated one-fifth of antenatal admissions and two-thirds of referrals to daytime assessment units4.”

• cites [4] Duley, L. The global impact of pre-eclampsia and eclampsia. Semin. Perinatol. 33, 130–137 (2009). sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The proportion of maternal deaths from hypertensive disorders in pregnancy was 2.8% in the UK and Ireland (2011-2013), and maternal mortality related to these disorders ranged between 0.08 and 0.42 per 100,000 pregnancies between 2009 and 2015.

“The proportion of maternal deaths from HDP was 2.8% in the UK and Ireland (2011–2013), whereas maternal mortality related to HDP ranged between 0.08 and 0.42 per 100,000 pregnancies between 2009 and 2015 (ref.46).”

• cites [46] Knight, M. et al. Saving lives, improving mothers’ care: lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2013–15. National Perinatal Epidemiology Unit https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/MBRRACE-UK%20Maternal%20Report%202017%20-%20Web.pdf (2017).Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

In France, hypertensive disorders in pregnancy account for one-quarter of obstetric admissions to intensive care units.

“In France, HDP account for one-quarter of obstetric admissions to intensive care units4.”

• cites [4] Duley, L. The global impact of pre-eclampsia and eclampsia. Semin. Perinatol. 33, 130–137 (2009). sourceNot checked — no full text of the source

May combine two claims.

Maternal social adversities result in insidious placental changes and/or malfunction and could lead to adverse outcomes during pregnancy and beyond.

“In accordance with epigenetic drivers and genetic predisposition, maternal social adversities result in insidious placental changes and/or malfunction and could lead to adverse outcomes during pregnancy and beyond.”

• AssumptionRests on an assumption: The association between maternal social adversities and unfavourable pregnancy outcomes with offspring health is established.

May combine two claims.

African American women and Filipino women have an increased risk of developing hypertensive disorders in pregnancy.

“For example, African American women and Filipino women have an increased risk of developing HDP112–114.”

• cites [112] Caughey, A. B., Stotland, N. E., Washington, A. E. & Escobar, G. J. Maternal ethnicity, paternal ethnicity, and parental ethnic discordance: predictors of preeclampsia. Obstet. Gynecol. 106, 156–161 (2005). sourceNot checked — no full text of the source
• cites [113] Rao, A. K., Cheng, Y. W. & Caughey, A. B. Perinatal complications among different Asian-American subgroups. Am. J. Obstet. Gynecol. 194, e39–e41 (2006). sourceNot checked — no full text of the source
• cites [114] Johnson, J. D. & Louis, J. M. Does race or ethnicity play a role in the origin, pathophysiology, and outcomes of preeclampsia? An expert review of the literature. Am. J. Obstet. Gynecol. 226, S876–S885 (2022). sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The theory of developmental origins of health and disease holds that prenatal and postnatal environments shape developmental trajectories and long-term health.

“The theory of developmental origins of health and disease underlines the role of both prenatal and postnatal environments in shaping developmental trajectories on long-term health204.”

• cites [204] Gluckman, P. D., Hanson, M. A. & Buklijas, T. A conceptual framework for the developmental origins of health and disease. J. Dev. Orig. Health Dis. 1, 6–18 (2010). sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The long-term impact of lifestyle interventions on neonates is rarely reported.

“The long-term impact of lifestyle interventions on neonates, such as diabetes mellitus and adiposity in adulthood and neurosensory disability in later childhood, is rarely reported.”

Probably not a substantial claim: may not pass S4 (based).

HDP and GDM have resulted in a large disease burden globally, especially among LMICs.

“HDP and GDM have resulted in a large disease burden globally, especially among LMICs.”

May combine two claims.

Evidence links HDP to later-life CVD and cerebrovascular disease in pregnant individuals, but it is unclear whether HDP impair the maternal CVD system or share common risk factors.

“Evidence also exists of a link between HDP and later-life CVD and cerebrovascular disease in pregnant individuals, although it is unclear whether HDP impair the maternal CVD system and result in future CVD in these pregnant individuals, or whether they share common risk factors209.”

• cites [209] Pittara, T., Vyrides, A., Lamnisos, D. & Giannakou, K. Pre-eclampsia and long-term health outcomes for mother and infant: an umbrella review. BJOG 128, 1421–1430 (2021). sourceNot checked — no full text of the source

May combine two claims.

In pandemics with lockdowns, it can be challenging for pregnant women to receive an oral glucose tolerance test and for those with hyperglycaemia to receive relevant health service visits.

“it can be challenging for pregnant women to receive an oral glucose tolerance test and for those with hyperglycaemia in pregnancy to receive relevant health service visits for diabetes education, glucose monitoring review, fetal ultrasonography and eye testing269.”

• cites [269] Murphy, H. R. Managing diabetes in pregnancy before, during, and after COVID-19. Diabetes Technol. Ther. 22, 454–461 (2020). sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

There are only a limited number of studies in women with GDM who are also infected with SARS-CoV-2.

“However, there are only a limited number of studies in women with GDM who are also infected with SARS-CoV-2.”

May combine two claims.

These factors might lead to decreased quality of care and worsen outcomes for patients with pre-existing diabetes mellitus in pregnancy and GDM.

“All these factors might lead to a decreased quality of care and worsen outcomes for patients with pre-existing diabetes mellitus in pregnancy and GDM.”

• AssumptionRests on an assumption: Women with CMDs in pregnancy require more intensive antenatal care than women with uncomplicated pregnancies.