I have been told that there is no risk to a fetus from episodic hypoglycemia.My wife has gone into insulin shock associated with her hypoglycemia several times, and has had seizures from insulin levels that were too much for her. I’m worried and I don’t want the child to have birth defects. I make sure to wake her up every night to eat something around 3:00 a.m. to avoid these episodes. What can I do to help our unborn child, and what are the odds of birth defects?

This is a very difficult question to answer since there is not very much data, if any, in humans on the effects of hypoglycemia on a developing fetus. From animal studies, it has been shown that there is some, but not a lot, of glucose reserve in the fetus that would support the baby if the mother has prolonged hypoglycemia. What is not well answered is whether or not this results in damage to the fetus. Probably brief hypoglycemia does not cause any long lasting effects. The concern about a seizure is whether the mother stopped breathing for any prolonged length of time, thus reducing oxygen delivery to the fetus. Once again, the fetus does have some mechanisms for dealing with a brief reduction in oxygenation, but prolonged lack of oxygen could cause some injury. The best way to manage this issue is to maintain calorie intake, frequently check blood sugars and promptly address any symptoms of hypoglycemia. In my practice, if a mother is having repeated hypoglycemic events, I will reduce her insulin dosing. It is much easier to deal with an overgrown baby, then a mother in a coma.

OWJ