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Diabetes Metab Res Rev. 2019 May 7:e3176. doi: 10.1002/dmrr.3176. [Epub ahead of print]

Impaired awareness of hypoglycemia: a new risk factor for adverse pregnancy outcomes in type 1 diabetes.

Author information

1
Endocrinology Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain.
2
University School of Nursing, Universitat de Barcelona, Barcelona, Spain.
3
Obstetrics and Gynecology Department, Hospital Clínic de Barcelona, Spain.
4
Diabetes Unit, Endocrinology Department, Hospital Clínic de Barcelona, Spain.

Abstract

AIM:

To evaluate the impact of impaired awareness of hypoglycemia (IAH) on metabolic control and pregnancy outcomes in women with type 1 diabetes.

MATERIAL AND METHODS:

This was a single-center prospective cohort study of singleton pregnant women with type 1 diabetes. IAH was assessed at the first antenatal visit using the Clarke's test (score≥3). Data on metabolic control, hypoglycemic events and the lipid profile were collected from prior to pregnancy and in each trimester of gestation. Pregnancy outcomes were also recorded.

RESULTS:

A total of 77 patients with type 1 diabetes were included; 24 (31.2%) were classified as having IAH. Compared with the normal awareness of hypoglycemia (NAH) group, the IAH group did not show differences in HbA1c, weight gain, insulin doses or severe and non-severe hypoglycemia events throughout pregnancy. IAH was associated with higher triglyceride concentrations in the second trimester (IAH: 154.8±61.1mg/dl, NAH: 128.6±31.2mg/dl, p=0.034) and an increased risk of neonatal respiratory distress (OR 11.24, CI95% 1.01-124.9, p=0.041) in adjusted models. Increased risk of preeclampsia was related to higher second trimester triglyceride concentrations (OR 1.028, CI 95% 1.004-1.053, p=0.023) adjusted for confounders.

CONCLUSIONS:

IAH was associated with increased risk of neonatal respiratory distress and preeclampsia, despite showing no differences in metabolic control. Hypoglycemia awareness in the first antenatal visit should be assessed to identify the subgroup of pregnant women with increased risk of complications.

KEYWORDS:

impaired awareness of hypoglycemia; pregnancy; type 1 diabetes

PMID:
31066196
DOI:
10.1002/dmrr.3176

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