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

In an analysis published in PLoS, investigators showed that Chinese women with low blood glucose levels before pregnancy were more likely to have adverse pregnancy outcomes. These can include preterm birth or low birth weight, according to the study authors.¹

Data reveal that women with low blood glucose before conception 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 [body mass index] 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 (ADA). 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. According to the ADA, continuous glucose monitors are increasingly used because they provide real-time glucose tracking and feature alarms that alert patients when levels drop too low.²

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

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

The investigators found that, compared with women with normal fasting plasma glucose (FPG) levels, those with prepregnancy hypoglycemia had higher multivariate-adjusted ORs for preterm birth (10%), low birth weight (8%), small for gestational age (7%), and birth defects (21%).

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, they need to continue training for diabetes care. According to study data published in the Journal of Pharmaceutical Health Services Research, most pharmacists say there needs to be better awareness of the impact of diabetes in pregnancy and prepregnancy. Pharmacists can adopt roles in medication safety, medication counseling, and health promotion 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. doi:10.1371/journal.pmed.1004667

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

3. About high and low blood sugar. University of Cincinnati College of Medicine. 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. J Pharm Health Services Res. 2021;12(3):377-389. doi:10.1093/jphsr/rmab019