Masked hypoglycemia in pregnancy.
BACKGROUND
Hypoglycemia is a major hindrance for optimal glycemic control in women with gestational diabetes mellitus (GDM) on insulin. In the present study, masked hypoglycemia (glucose <2.77mmol/L for ≥30 min) was estimated in pregnant women using a continuous glucose monitoring (CGM) system.


METHODS
Twenty pregnant women with GDM on insulin (cases) and 10 age-matched euglycemic pregnant women (controls) between 24 and 36 weeks gestation were recruited. Both groups performed self-monitoring of blood glucose (SMBG) and underwent CGM for 72 h to assess masked hypoglycemia. Masked hypoglycemic episodes were further stratified into two groups based on interstitial glucose (2.28-2.77 and ≤2.22 mmol/L).


RESULTS
Masked hypoglycemia was recorded in 35% (7/20) of cases and 40% (4/10) of controls using CGM, with an average of 1.28 and 1.25 episodes per subject, respectively. Time spent at glucose levels between 2.28 and 2.77 mmol/L did not differ between the two groups (mean 114 vs 90 min; P = 0.617), but cases spent a longer time with glucose ≤2.2 mmol/L. Babies born to women with GDM were significantly lighter than those born to controls (2860 vs 3290 g; P = 0.012). There was no significant difference in birth weight within the groups among babies born to women with or without hypoglycemia.


CONCLUSIONS
Euglycemic pregnant women and those with GDM on insulin had masked hypoglycemia. Masked hypoglycemia was not associated with adverse maternal or fetal outcomes. Therefore, low glucose levels in the hypoglycemic range may represent a physiologic adaptation in pregnancy. This response is exaggerated in women with GDM on insulin.
Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India.
Dukhabandhu
D
Naik
Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India.
Asha
A
Hesarghatta Shyamasunder
Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India.
Mahesh
M
Doddabelavangala Mruthyunjaya
Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India.
Rita
R
Gupta Patil
Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India.
Thomas Vizhalil
TV
Paul
Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India.
Flory
F
Christina
Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India.
Mercy
M
Inbakumari
Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India.
Ruby
R
Jose
Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India.
Jessie
J
Lionel
Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India.
Annie
A
Regi
Biostatistics, Christian Medical College, Vellore, India.
P Visalakshi
PV
Jeyaseelan
Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India.
Nihal
N
Thomas
D000328:Adult; D016022:Case-Control Studies; D016640:Diabetes, Gestational / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000150:complications / Q000175:diagnosis*; D007328:Insulin / Q000627:therapeutic use; D011247:Pregnancy; D011256:Pregnancy Outcome
D007328:Insulin
continuous glucose monitoring; gestational diabetes mellitus; masked hypoglycemia; 动态血糖监测; 妊娠糖尿病; 隐性低血糖