Hypoglycaemia during pregnancy in women with Type 1 diabetes

TY - JOUR

T1 - Hypoglycaemia during pregnancy in women with Type 1 diabetes

AU - Nielsen, Lene Ringholm

AU - Pedersen-Bjergaard, U

AU - Thorsteinsson, B

AU - Damm, P

AU - Mathiesen, E R

N1 - © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

PY - 2012/5

Y1 - 2012/5

N2 - Aims To explore incidence, risk factors, possible pathophysiological factors and clinical management of hypoglycaemia during pregnancy in women with Type1 diabetes. Methods Literature review. Results In women with Type1 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 HbA 1c in early pregnancy, fluctuating plasma glucose values (≤3.9mmol/l or ≥10.0mmol/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 Type1 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.

AB - Aims To explore incidence, risk factors, possible pathophysiological factors and clinical management of hypoglycaemia during pregnancy in women with Type1 diabetes. Methods Literature review. Results In women with Type1 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 HbA 1c in early pregnancy, fluctuating plasma glucose values (≤3.9mmol/l or ≥10.0mmol/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 Type1 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.

U2 - 10.1111/j.1464-5491.2012.03604.x

DO - 10.1111/j.1464-5491.2012.03604.x

M3 - Journal article

C2 - 22313112

SN - 0742-3071

VL - 29

SP - 558

EP - 566

JO - Diabetic Medicine

JF - Diabetic Medicine

IS - 5

ER -