Impaired hypoglycemia awareness leads to more severe episodes during pregnancy
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Pregnant women with type 1 diabetes and impaired hypoglycemia awareness have greater fear and more episodes of severe hypoglycemia than those with normal awareness, particularly in the first trimester, according to study data.
“Providers should be cognizant of this increased risk and take steps to prevent the hypoglycemia, such as make available to patients continuous glucose monitoring with closed loop technology,” Denice S. Feig, MD, professor of medicine obstetrics and gynecology, and health policy, management and evaluation at the University of Toronto, told Healio. “The good news was that their infant outcomes were not worse.”
Researchers analyzed data as part of a substudy of 214 pregnant women with type 1 diabetes who participated in CONCEPTT, a randomized trial assessing maternal and neonatal outcomes using real-time continuous glucose monitoring for pregnant women with type 1 diabetes. In the substudy, researchers compared glycemic, maternal and neonatal outcomes among women with impaired awareness of hypoglycemia (n = 64) and with normal hypoglycemia awareness (n = 150). Hypoglycemia fear surveys were conducted at baseline. Glycemic outcomes were measured at baseline, 24 weeks of gestation and 34 weeks of gestation.
The findings were published in Diabetic Medicine.
No differences in HbA1c were observed between the groups. Women with impaired awareness spent more time below range at baseline compared with the normal awareness group (10.4% vs. 8%; P = .034) and had more glycemic variability. However, there were no differences in any CGM measures at 24 and 34 weeks. The mean number of severe hypoglycemia episodes was higher among women with impaired awareness at baseline and throughout pregnancy.
Women with impaired hypoglycemia awareness had lower gestational weight gain compared with the normal hypoglycemia awareness group (12.4 kg vs. 14.2 kg; P = .043). No other differences were observed in maternal or neonatal outcomes.
Women with impaired hypoglycemia awareness had higher overall hypoglycemia fear and higher scores on the worry scale of the hypoglycemia fear survey compared with those with normal awareness. Those with more hypoglycemia fear had a higher rate of maternal severe hypoglycemia episodes (RR = 1.78; 95% CI, 1.39-2.27) and a greater likelihood for diabetic nephropathy (OR = 1.9; 95% CI, 1.1-3.4) and were less likely to have neonatal hypoglycemia (OR = 0.68; 95% CI, 0.45-1).
“An unexpected finding of our study was that increased fear of hypoglycemia was associated with reduced neonatal hypoglycemia,” the researchers wrote. “We would have expected patients with more fear of hypoglycemia to have higher glycemic excursions or overall glycemic control above target, leading to more neonatal hypoglycemia, but we have in fact found the opposite. The reason for this is unknown.”
Feig said more research is needed to develop ways to prevent hypoglycemic episodes in those with impaired awareness.
For more information:
Denice Feig, MD, can be reached at d.feig@utoronto.ca.
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