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Hypoglycemia incidence highest in early pregnancy
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Forty-five percent of women with type 1 diabetes had severe hypoglycemic events early in pregnancy.
Researchers in Copenhagen conducted a prospective study of 108 pregnant women with type 1 diabetes to evaluate the occurrence of mild and severe hypoglycemia.
Self-monitored plasma glucose tests were performed for three days at eight, 14, 21, 27 and 33 weeks of gestation. Participants answered questions about nausea, vomiting, hypoglycemia awareness and history of hypoglycemia.
There were 178 severe hypoglycemic events; 5.3 events per patient year occurred in the first trimester, 2.4 events in the second and 0.5 events in the third. Mild hypoglycemia incidence was 5.5 events per patient week in early pregnancy with a decrease occurring throughout pregnancy (P<.0001).
Independent predictors of severe hypoglycemia were history of severe hypoglycemia the year prior to pregnancy (OR=3.3; 95% CI, 1.2-9.2) and impaired awareness or unawareness of hypoglycemia (OR=3.2; 95% CI, 1.2-8.2). – by Christen Haigh
Diabetes Care. 2008;31:9-14.
One of the most common risks that pregnant women with diabetes face is severe hypoglycemia. It is a significant risk and can cause serious morbidity and even mortality, and loss of consciousness or altered mental status is associated with severe hypoglycemia. As diabetes care-givers to pregnant women, we are trying to achieve normal control of blood glucoses in order to decrease the risk for birth defects and some fetal complications, such as macrosomia. Yet, we have to always be aware that when we lower our blood glucose targets for these women, we are putting them at increased risk for severe hypoglycemia. This study is showing that 45% of the women enrolled in the study had severe hypoglycemia, so it is a very common risk that women face. Endocrinologists and physicians who care for these women should take a look at whether women have a history of severe hypoglycemia in the last year or if they have hypoglycemia unawareness or impaired recognition of low blood sugars. In these women, you may have to raise your targets a little bit to keep them safe. Also, these women need to monitor their blood sugars frequently. In this study, they were testing seven times a day, minimum, and then once a week at three o’clock in the morning, and in spite of high frequency of testing, they were still having hypoglycemia. Perhaps these women should have access to a continuous glucose monitoring system in the first trimester of pregnancy, when the risk for severe hypoglycemia is the greatest.
– Florence Brown, MD
Co-director of the Diabetes and Pregnancy Program at the Joslin Diabetes Center and Beth Israel Deaconess Medical Center in Boston