Hypoglycemia is a term used to describe low blood sugar. Diabetes and many other health conditions can cause hypoglycemia. When a person has low blood sugar, they may find it difficult to concentrate or think and may experience confusion, shakiness, anxiety, and heart palpitations. When a woman is pregnant, there is a chance that she develops hypoglycemia because of the change in which the body regulates and metabolizes glucose during pregnancy. Hypoglycemia is known to commonly affect women who have gestational diabetes or diabetes. Many people believe that there is a link between hypoglycemia and pregnancy. Whether this is actually the truth or just a myth can only be determined by looking at what the research shows. Read on to find out whether there is a connection between hypoglycemia and pregnancy.
Overview of Insulin & Glucose Production and Hypoglycemia
Our body produces the hormone insulin to move blood sugar, or glucose from the bloodstream into the cells, where glucose is stored to be used for energy as and when needed by the body.(1,2,3) During pregnancy, however, the body starts to produce more insulin to help the fetus grow and develop.(4,5) At the same time, pregnancy can make some women become more resistant to insulin, a condition known as insulin resistance. This is the reason why many women develop diabetes during their pregnancy, a condition known as gestational diabetes.(6,7)
Though it is more common to have high blood sugar, or hyperglycemia, in pregnancy, but the changes that occur in the body during pregnancy and how each person reacts to insulin can also cause your blood sugar to fall to dangerously low levels.(8,9) This can cause a condition known as hypoglycemia. Having a blood sugar reading of less than 60 milligrams per deciliter (mg/dL) is considered as hypoglycemia. Hypoglycemia in pregnancy happens more in women who had diabetes either before getting pregnant or developed gestational diabetes.(10)
Hypoglycemia and Pregnancy
Women who already have diabetes before getting pregnant are more susceptible to developing hypoglycemia during their pregnancy. A 2008 study carried out on pregnant women participants with type 1 diabetes found that almost 45 percent of them experienced episodes of hypoglycemia, especially during the first and second trimesters. (11)
As mention above, insulin is the hormone that controls the body’s glucose or blood sugar levels. When you are pregnant, the body needs more insulin since the placenta starts producing excess glucose. Added to this, the hormonal changes can also make it challenging for your body to regulate glucose.
If your body is not able to produce an adequate amount of insulin, you may end up developing gestational diabetes. Women are also more likely to become insulin resistant as the pregnancy progresses, meaning that the body stops responding appropriately to insulin.(12)
Due to these factors, there is a greater risk of a pregnant woman developing hyperglycemia or high blood sugar. However, it is also possible for many women to develop hypoglycemia or fluctuate between the two conditions.
What are the Causes of Hypoglycemia in Pregnancy?
Persistent hypoglycemia in pregnant women who do not have diabetes is usually rare. However, sugar levels can fall to low levels during pregnancy due to the following causes:
- You are not eating frequently enough, or you are not eating the right foods that can help stabilize your blood sugar levels. Regardless of how often or how much you eat, your baby will keep on taking the glucose from your body, and your body needs to work to compensate for this loss of glucose.
- You are exercising excessively, thus using up the glucose in the body. If your body is not able to produce enough glucose or you do not replenish it by consuming carbohydrates, you are at risk of developing hypoglycemia. Though keep in mind that excessive exercising during pregnancy is not recommended.
- The dosage of your diabetes medication is too effective at lowering your blood sugar levels and needs to be adjusted. This is one of the most common reasons behind why women develop hypoglycemia during pregnancy.
Hypoglycemia can also occur in pregnant women who do not have a history of diabetes. However, hypoglycemia is much more likely to be observed in women who are taking insulin.(13) Each type of diabetes is known to increase the risk of having hypoglycemic episodes during pregnancy, including type 1 diabetes, type 2 diabetes, and gestational diabetes.
What are the Symptoms of Hypoglycemia During Pregnancy?
The symptoms of hypoglycemia are more or less the same in people who are not pregnant and in pregnant women. The common symptoms include:(14)
- Nausea or vomiting
- Heart palpitations
- Pale skin
- Tingling sensation around the mouth
- Moodiness and anger, or feeling extreme irritation
- Irregular or fast heartbeat
- Difficulty thinking clearly
It is important to note that if a person has severe hypoglycemia, they are also going to experience more serious symptoms, which may include convulsions, loss of consciousness, or seizures.
Once your blood sugar levels increase again, these symptoms will disappear.(15)
How Common is Hypoglycemia During Pregnancy?
Experiencing hypoglycemia during pregnancy is more common than most people think. Women who have a history of diabetes are much more likely to develop hypoglycemia than women who don’t have diabetes. In a 2010 study, it was found that 23 percent of women with type 1 diabetes experienced a severe hypoglycemic attack at least once during their pregnancy, while many women even had several such attacks.(10) A severe hypoglycemic attack occurs when the blood sugar level falls so dangerously low that there is a risk of losing consciousness or having seizures.
An older study found that around 19 to 44 percent of pregnant women who have diabetes of all kinds experienced hypoglycemia.(16)
What are the Risk Factors for Hypoglycemia During Pregnancy?
Hypoglycemia can happen at any time during your pregnancy, but there are certain factors that increase the risk of hypoglycemia. These risk factors may include:
- Having a History Of Diabetes: Both diabetes and being pregnant cause fluctuations in your insulin levels. To avoid having either too little or too much blood sugar, you need to be carefully monitored during the course of your pregnancy, and you may also need some adjustments made to your diabetes medications.(17)
- Having had hypoglycemic episodes before your pregnancy.
- Being in your first trimester: Hypoglycemic episodes are more likely to occur during the first trimester when most mothers experience nausea and vomiting. A 2008 study carried out in pregnant women with type 1 diabetes experienced severe hypoglycemia almost three times more regularly in the first trimester than the period before pregnancy.(11) The most likely time period to have a severe hypoglycemic episode is between 8 and 16 weeks of pregnancy. The risk goes down as your pregnancy progresses, and the least likely time to have a severe hypoglycemic attack is during the second pregnancy.
- Being malnourished: It is important that you are consuming enough calories when you are pregnant. You should also be eating a nutritious and well-balanced diet.
- Being ill: Many diseases can lead to a lack of appetite, and without having regular or adequate food intake, you may end up developing hypoglycemia.
How is Hypoglycemia during Pregnancy Diagnosed?
Your doctor will diagnose hypoglycemia after understanding your symptoms and looking at your blood sugar/glucose readings. They may ask you to take several blood glucose readings during the day and maintain records of them. Your doctor can either prescribe a blood sugar monitoring kit to you, or you can buy it from any drugstore. However, remember that having just one low blood sugar reading does not indicate that you have hypoglycemia.
Treatment Prevention of Hypoglycemia During Pregnancy
If you are experiencing any of the symptoms of hypoglycemia, here are some steps to take:
- First of all, find a safe place to sit or lie. In case you are driving, you should pull over at the earliest.
- Eat or drink at least 15 grams of carbohydrates.(18) Simple carbohydrates have a higher sugar content and are recommended in case of hypoglycemia. Examples include four ounces of fruit juice (make sure you don’t choose diet or reduced sugar drinks), four glucose tablets, one tablespoon of honey or sugar, or half a can of regular soda. It is a good idea to always keep such supplies with you, especially if you have diabetes, gestational diabetes, or any other condition that may make your blood sugar levels fall.
- Let your doctor know of any hypoglycemic attacks you have.
If you have diabetes, your doctor will need to make adjustments to your medication dosage to maintain stability in your blood sugar levels. In some rare cases, you might be prescribed a glucagon kit. A glucagon kit contains a synthetic form of the glucagon hormone and a sterile syringe. When you inject the glucagon, it will immediately stimulate your liver to release the stored glucose, which in turn will raise your blood sugar levels. This is used only as a rescue treatment for severe hypoglycemia.(19,20)
The most important thing to prevent episodes of hypoglycemia, though, is to reduce your risk of having an attack in the first place. Here are some prevention tips you should follow if you are pregnant to reduce the risk of hypoglycemia:
- East small, but frequent and well-balanced meals to keep your blood sugar levels stable.
- When you are sleeping, the body is in a state of fasting. This is why it is recommended that you have a snack handy by your bedside so that you can eat that if you feel hungry in the night or first thing in the morning after waking up.
- Exercise regularly, but only under strict advice from your doctor. Do not go beyond your normal level of exercise. The effects of excessive exercise on your blood sugar can continue for nearly 24 hours, so it is important to monitor your symptoms.(21)
Having an occasional episode of hypoglycemia during your pregnancy is unlikely to cause any harm to either you or your baby. However, if it becomes frequent, it can cause problems since the brain needs glucose to continue receiving messages from the body and to work on these messages. In severe cases in women with diabetes, hypoglycemia may even cause seizures, coma, or even death. Your baby may also experience the same type of complications if they are born with hypoglycemia or they develop the condition soon after birth.
While hypoglycemia is not that common during pregnancy, if you do not have diabetes, it can sometimes happen. There is no sure-shot way of preventing hypoglycemia, but you can try to reduce your risk by eating regularly, morning your blood sugar levels if you have diabetes, and strictly following your doctor’s advice.
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- Rowe, J.W., Young, J.B., Minaker, K.L., Stevens, A.L., Pallotta, J. and Landsberg, L., 1981. Effect of insulin and glucose infusions on sympathetic nervous system activity in normal man. Diabetes, 30(3), pp.219-225.
- de Valk, H.W. and Visser, G.H., 2011. Insulin during pregnancy, labour and delivery. Best practice & research Clinical obstetrics & gynaecology, 25(1), pp.65-76.
- Spellacy, W.N. and Goetz, F.C., 1963. Plasma insulin in normal late pregnancy. New England Journal of Medicine, 268(18), pp.988-991.
- Bellmann, O. and Hartmann, E., 1975. Influence of pregnancy on the kinetics of insulin. American Journal of Obstetrics and Gynecology, 122(7), pp.829-833.
- Leikin, E., Jenkins, J.H. and Graves, W.L., 1987. Prophylactic insulin in gestational diabetes. Obstetrics and gynecology, 70(4), pp.587-592.
- ter Braak, E.W., Evers, I.M., Willem Erkelens, D. and Visser, G.H., 2002. Maternal hypoglycemia during pregnancy in type 1 diabetes: maternal and fetal consequences. Diabetes/metabolism research and reviews, 18(2), pp.96-105.
- Rosenn, B.M., Miodovnik, M., Khoury, J.C. and Siddiqi, T.A., 1996. Counterregulatory hormonal responses to hypoglycemia during pregnancy. Obstetrics & gynecology, 87(4), pp.568-574.
- Heller, S., Damm, P., Mersebach, H., Skjøth, T.V., Kaaja, R., Hod, M., Durán-García, S., McCance, D. and Mathiesen, E.R., 2010. Hypoglycemia in type 1 diabetic pregnancy: role of preconception insulin aspart treatment in a randomized study. Diabetes care, 33(3), pp.473-477.
- Nielsen, L.R., Pedersen-Bjergaard, U., Thorsteinsson, B., Johansen, M., Damm, P. and Mathiesen, E.R., 2008. Hypoglycemia in pregnant women with type 1 diabetes: predictors and role of metabolic control. Diabetes Care, 31(1), pp.9-14.
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