Issue 96 Item 7 Risk Factors Identified For Severe Hypoglycemia During First Tri

Severe hypoglycemia occurred almost three times more often in the first trimester Several factors associated with the increased risk of severe hypoglycemia during the first trimester of pregnancy have been identified in type I diabetic women.

Investigators from the University Medical Center at Utrecht University in Utrecht, the Netherlands, found that history of severe hypoglycemia before gestation, longer duration of diabetes, hemoglobin A1c (HbA1c) level less than or equal to 6.5 percent and higher total daily insulin dose were all predictive for severe hypoglycemia in the first trimester of type I diabetic pregnancy.

These results are from a longitudinal cohort survey of 278 pregnant women with type 1 diabetes. Frequencies of severe hypoglycemia and hypoglycemic coma, general characteristics, hypoglycemic awareness, blood glucose symptom threshold and Hypoglycemic Fear Survey were assessed at inclusion into the study and at 17 weeks of gestation.

Results showed that, overall, severe hypoglycemia occurred almost three times more often in the first trimester versus the four months before gestation (2.6 ± 6.3 versus 0.9 ± 2.4 episodes). The proportion of women affected by severe hypoglycemia increased from 25 to 41 percent during the first trimester.

Further research, according to the investigators, should address the benefits that strict glycemic control has in balancing the increased risk of severe hypoglycemia in early type I diabetic pregnancy. Diabetes Care 2002; 25(3): 554-559