Hypoglycaemia during pregnancy in women with Type 1 diabetes
Article first published online: 16 APR 2012
© 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK
Volume 29, Issue 5, pages 558–566, May 2012
How to Cite
Ringholm, L., Pedersen-Bjergaard, U., Thorsteinsson, B., Damm, P. and Mathiesen, E. R. (2012), Hypoglycaemia during pregnancy in women with Type 1 diabetes. Diabetic Medicine, 29: 558–566. doi: 10.1111/j.1464-5491.2012.03604.x
- Issue published online: 16 APR 2012
- Article first published online: 16 APR 2012
- Accepted manuscript online: 7 FEB 2012 11:40AM EST
- Accepted 31 January 2012
- hypoglycaemia awareness;
- Type 1 diabetes
Diabet. Med. 29, 558–566 (2012)
Aims To explore incidence, risk factors, possible pathophysiological factors and clinical management of hypoglycaemia during pregnancy in women with Type 1 diabetes.
Methods Literature review.
Results In women with Type 1 diabetes, severe hypoglycaemia occurs three to five times more frequently in early pregnancy than in the period prior to pregnancy, whereas in the third trimester the incidence of severe hypoglycaemia is lower than in the year preceding pregnancy. The frequency distribution of severe hypoglycaemia is much skewed, as 10% of the pregnant women account for 60% of all recorded events. Risk factors for severe hypoglycaemia during pregnancy include a history with severe hypoglycaemia in the year preceding pregnancy, impaired hypoglycaemia awareness, long duration of diabetes, low HbA1c in early pregnancy, fluctuating plasma glucose values (≤ 3.9 mmol/l or ≥ 10.0 mmol/l) and excessive use of supplementary insulin injections between meals. Pregnancy-induced nausea and vomiting seem not to be contributing factors.
Conclusions Striving for near-normoglycaemia with focus on reduction of plasma glucose fluctuations during pregnancy should have high priority among clinicians with the persistent aim of improving pregnancy outcome among women with Type 1 diabetes. Pre-conception counselling, carbohydrate counting, use of insulin analogues, continuous subcutaneous insulin infusion (insulin pump) therapy and real-time continuous glucose monitoring with alarms for low glucose values might be relevant tools to obtain near-normoglycaemia without episodes of severe hypoglycaemia.