From the Guidelines
Hyperglycemia is more commonly seen in pregnancy than hypoglycemia. During pregnancy, the body undergoes hormonal changes that naturally increase insulin resistance, particularly in the second and third trimesters, as noted in the 2024 standards of care in diabetes 1. This physiological adaptation occurs primarily due to placental hormones like human placental lactogen, progesterone, and cortisol, which antagonize insulin action to ensure adequate glucose supply to the developing fetus. As a result, approximately 2-10% of pregnant women develop gestational diabetes mellitus (GDM), characterized by hyperglycemia that first appears or is first diagnosed during pregnancy.
Management typically involves blood glucose monitoring, dietary modifications, exercise, and sometimes insulin therapy if blood glucose targets aren't met with lifestyle changes alone. Insulin is the preferred medication for treating hyperglycemia in pregnancy, as oral hypoglycemic agents like metformin and glyburide may be used in some cases but are generally considered second-line options, according to the 2023 standards of care in diabetes 1. While hypoglycemia can occur in pregnant women with pre-existing diabetes who use insulin or certain medications, it is less common than hyperglycemia in the general pregnant population.
Key points to consider in managing diabetes in pregnancy include:
- The importance of medical nutrition therapy to establish a food plan and insulin-to-carbohydrate ratio, as highlighted in the 2024 standards of care in diabetes 1
- The need for frequent titration of insulin to match changing requirements during pregnancy, as noted in the 2023 standards of care in diabetes 1
- The recommendation for referral to a specialized center offering team-based care for pregnant individuals with preexisting diabetes, as suggested in the 2023 standards of care in diabetes 1
- The preference for insulin over oral hypoglycemic agents in treating hyperglycemia in pregnancy, as stated in the 2023 standards of care in diabetes 1.
From the Research
Hyperglycemia in Pregnancy
- Hyperglycemia is the most common medical condition affecting pregnancy, with its incidence increasing globally 2.
- The risk of immediate complications during pregnancy generally rises with more severe hyperglycemia 2.
- Hyperglycemia in pregnancy is associated with short-term pregnancy complications, such as excess fetal growth and adiposity, and pregnancy-related hypertensive disorders 3.
Comparison with Hypoglycemia
- There is no mention of hypoglycemia being more common than hyperglycemia in pregnancy in the provided studies.
- The studies focus on the diagnosis, treatment, and management of hyperglycemia in pregnancy, suggesting that it is a more significant concern 4, 2, 5, 3, 6.
Prevalence of Hyperglycemia
- Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy, with a increasing prevalence of undiagnosed hyperglycemia and overt diabetes in young women 3.
- The prevalence of hyperglycemia in pregnancy is increasing globally, in parallel with the twin epidemics of diabetes and obesity 2.