Women With Hypoglycemia Prior to Pregnancy Are More Likely to Have Adverse Outcomes

In an analysis published in PLoS, investigators found that women who are Chinese with low blood sugar levels prior to pregnancy were more likely to have adverse pregnancy outcomes. Adverse pregnancy outcomes can include preterm birth or low birthweight, according to the study authors.¹

Study reveals that women with low preconception blood sugar face higher risks of adverse pregnancy outcomes, emphasizing the need for screening and education. | Image Credit: artursfoto - stock.adobe.com

“Maternal preconception hypoglycemia is significantly associated with various adverse pregnancy outcomes, and maternal preconception BMI could modify the impact of preconception hypoglycemia,” the study authors wrote.¹

During pregnancy, blood glucose targets are typically lower due to the effects of high blood pressure on the infant, according to the American Diabetes Association. However, this can also pose a risk for a lower blood glucose level, which can be harder to detect during pregnancy. Checking blood glucose is an essential part of pregnancy, and the organization states that continuous glucose monitors are being used more frequently due to the ability for continuous monitoring and an alarm that will alert the patient if their glucose goes too low.²

Diabetes can cause unexpected miscarriage, preterm labor and delivery, polyhydramnios, kidney infection, or cesarean birth, and low blood glucose can be caused by not eating enough, exercising too much, or taking too much medication. Low blood sugar can manifest as being shaky, dizziness, feeling anxious or irritable, a fast heartbeat, sweating, hunger, blurred vision, weakness, headache, or numbness or tingling around the mouth.³

In the current study, the investigators included data on 4.8 million women from China to determine an association between preconception hypoglycemia and adverse pregnancy outcomes, which included medical abortion, miscarriage or early gestational stillbirth, preterm birth, macrosomia, large for gestational age, small for gestational age, birth defects, and perinatal death. There were approximately 4.91% of women who had preconception hypoglycemia.¹

Compared with normal fasting plasma glucose (FPG), women who had prepregnancy hypoglycemia had increased inverse probability treatment weighing-multivariate adjusted odds ratios of preterm birth by 10%, low birth weight by 8%, small for gestational age by 7%, and birth defects by 21%, according to the study authors. However, there were decreases for medical abortion by 6%, miscarriage or early stillbirth by 5%, macrosomia by 12%, and large for gestational age by 12%. Furthermore, investigators found that FPG decreased the risk of medical abortion, miscarriage or early stillbirth, and large for gestational age but increased the risk of preterm birth and small for gestational age.¹

“Our findings indicated that further attention should be paid to women with hypoglycemia prior to pregnancy, and screening for preconception hypoglycemia might be worth exploring as a means to reduce adverse pregnancy outcomes,” the study authors wrote.¹ “Participants who have preconception hypoglycemia might require referral for a more comprehensive examination to ascertain the detailed cause and appropriate medical treatment before they get pregnant to reduce adverse pregnancy outcomes.”

Pharmacists play a large role in diabetes education, which can include promoting healthy glucose levels prior to pregnancy. However, pharmacists need to continue training for diabetes care, with most pharmacists in a study published in the Journal of Pharmaceutical Health Services and Research stating that there needs to be better awareness of the impact of diabetes in pregnancy and pre-pregnancy. Medication safety, medication counseling, and health promotion are all roles that pharmacists can take to help identify patients who might be unaware of the adverse pregnancy outcomes of hypoglycemia.⁴

READ MORE: Diabetes Resource Center

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REFERENCES

1. Wu H, Yang Y, Zhao C, et al. Preconception hypoglycemia and adverse pregnancy outcomes in Chinese women aged 20-49 years: A retrospective cohort study in China. PLoS Med. 2025;22(7):e1004667. Published 2025 Jul 29. doi:10.1371/journal.pmed.1004667

2. American Diabetes Association. Diabetes and Pregnancy. Accessed July 31, 2025. https://diabetes.org/living-with-diabetes/pregnancy

3. University of Cincinnati College of Medicine. About high and low blood sugar. Accessed July 30, 2025. https://med.uc.edu/depart/ob/divisions/mfm/diabetes-pregnancy-programs/about-high-and-low-blood-sugar

4. Garsia K, MacMillan F, Dune T, Simmons D. The role of the pharmacist in contraception and pre-pregnancy management for women with diabetes: a study of patient and pharmacist perspectives. JPHSR. 2021. doi: https://doi.org/10.1093/jphsr/rmab019