Feature Article

Hypoglycemia in pregnant women with type 1 diabetes: clinical features and management

Lene Ringholm, MD, PhD; Ulrik Pedersen-Bjergaard, MD, DMSc; Birger Thorsteinsson, MD, DMSc; Peter Damm, MD, DMSc; Elisabeth R. Mathiesen, MD, DMSc

Diabetic Hypoglycemia January 2011, Volume 3, Issue 3: page 3-7

In women with type 1 diabetes, severe hypoglycemia occurs three to five times more frequently in early pregnancy compared with the period prior to pregnancy, whereas in the third trimester, the incidence is lower than in the year preceding pregnancy. The frequency distribution of severe hypoglycemia is highly skewed as 10% of pregnant women account for 60% of all recorded events. Risk factors for severe hypoglycemia during pregnancy include a history with severe hypoglycemia the year preceding pregnancy, impaired hypoglycemia awareness, a longer duration of diabetes, lower glycated hemoglobin (HbA1c) in early pregnancy, fluctuating plasma glucose values, and excessive supplementary insulin injections between meals. Pregnancy induced nausea and vomiting are not contributing factors. Treatment with insulin analogs and/or insulin pumps may reduce the risk of severe hypoglycemia during pregnancy. Real-time continuous glucose monitoring with hypoglycemia alarms may be useful in preventing severe hypoglycemia.

Keywords: hypoglycemia, pregnancy, type 1 diabetes management, trimester, hypoglycemia awareness, glycated hemoglobin, insulin analogs, insulin pump, continuous glucose monitoring