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. 2022 May;39(5):e14789.
doi: 10.1111/dme.14789. Epub 2022 Jan 30.

Impaired awareness of hypoglycaemia in women with type 1 diabetes in pregnancy: Hypoglycaemia fear, glycaemic and pregnancy outcomes

Jasmine Bahrami  1   2 , George Tomlinson  1   3 , Helen R Murphy  4   5 , Denice S Feig  1   2   6 ; CONCEPTT Collaborative Group
Affiliations

Impaired awareness of hypoglycaemia in women with type 1 diabetes in pregnancy: Hypoglycaemia fear, glycaemic and pregnancy outcomes

Jasmine Bahrami et al. Diabet Med. 2022 May.

Abstract

Aims: To examine maternal fear of hypoglycaemia, glycaemia and pregnancy outcomes in women with impaired and normal awareness of hypoglycaemia.

Methods: A pre-planned sub-study of 214 pregnant women with type 1 diabetes who participated in the CONCEPTT trial. Participants completed hypoglycaemia fear surveys (HFS-II) at baseline. Logistic regression and Poisson regression analyses were used to obtain an adjusted estimate for the rate ratio relating awareness to the number of severe hypoglycaemic episodes, and for several neonatal outcomes in relation to the total HFS-II score. The role of continuous glucose monitoring (CGM) use was examined.

Results: Overall, 30% of participants reported impaired awareness of hypoglycaemia (n = 64). Women with impaired awareness of hypoglycaemia had more episodes of severe hypoglycaemia (mean 0.44 vs. 0.08, p < 0.001) (12-34 weeks gestation) and scored higher on the HFS-II scale (43.7 vs. 36.0, p 0.008), indicating more fear of hypoglycaemia. They spent more time below range (CGM <3.5 mmol/L) and exhibited more glycaemic variability at 12 weeks gestation. Higher overall HFS-II scores were associated with a higher risk of maternal severe hypoglycaemia episodes (Rate Ratio 1.78, 95% CI 1.39-2.27). Women with impaired awareness of hypoglycaemia had less maternal weight gain but there were no differences in neonatal outcomes between women with impaired awareness of hypoglycaemia and normal hypoglycaemia awareness. Higher HFS-II scores were associated with more nephropathy (Odds Ratio 1.91, 95% CI 1.06-3.4). CGM use after 12 weeks was not associated with the number of episodes of severe hypoglycaemia (RR 0.75, 95% CI 0.49-1.15; p = 0.18).

Conclusions: In pregnant women with type 1 diabetes, impaired awareness of hypoglycaemia is associated with more maternal severe hypoglycaemia episodes and more fear of hypoglycaemia. Having impaired awareness of hypoglycaemia and/or fear of hypoglycaemia should alert clinicians to this increased risk. Reassuringly, there was no increase in adverse neonatal outcomes.

Keywords: diabetes mellitus; diabetes mellitus type 1; hypoglycaemia; pregnancy; pregnancy complications; pregnancy in diabetes; pregnancy outcomes; severe hypoglycaemia.

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Conflict of interest statement

DSF and HRM report grants from the Juvenile Diabetes Research Foundation during the conduct of the CONCEPTT study. DSF sits on the EXPECT Advisory Panel and reports personal fees from Novo Nordisk outside the submitted work. HRM reports personal fees from Novo Nordisk, Roche, and Medtronic, outside the submitted work. HRM sits on the Medtronic European Scientific Advisory Board. All remaining authors declare no competing interests.

Figures

FIGURE 1
FIGURE 1
Per cent of time spent in the target range, above the target range and below the target range by hypoglycaemia awareness. IAH, impaired awareness of hypoglycaemia; NAH, normal awareness of hypoglycaemia. Per cent time below target at baseline (12 weeks) was higher in the impaired awareness of hypoglycaemia group compared to the NAH group, p = 0.034
See this image and copyright information in PMC

References

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