Pregnancy is *supposed* to be a magical time. But between the backaches, swollen feet, and frequent trips to the whiz palace, anticipating your changing body’s needs can be as difficult as tying your own shoes.

A change that may be less obvious has to do with your blood sugar, or glucose. During pregnancy, the placenta produces extra glucose to support your baby’s growth. As a result, your body needs more insulin to help control those glucose levels.

At the same time, hormone changes may cause your body to respond less to insulin. Called insulin resistance, this is a natural occurrence that ensures enough glucose in your bloodstream is being passed to your baby.

If there isn’t enough insulin to move glucose out of your blood, your blood sugar levels may rise. This can result in two things, both of which are common during pregnancy: high blood sugar (called hyperglycemia) and gestational diabetes.

You don’t have to be diabetic to develop gestational diabetes, and developing gestational diabetes doesn’t mean you’ll be diabetic after pregnancy. Between 2 and 10 percent of pregnancies are affected by gestational diabetes and symptoms, overall, tend to be mild.

Though less common than hyperglycemia, the inverse — low blood sugar — can also occur during your pregnancy. In fact, hyperglycemia and hypoglycemia can happen concurrently.

Read on to learn more about the causes of hypoglycemia, its symptoms, and how to keep it from impacting you and your little one’s health.

What’s considered low blood sugar during pregnancy?

A blood sugar reading of less than 60 milligrams per deciliter (mg/dL) is considered hypoglycemic.

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The leading cause of hypoglycemia during pregnancy is diabetes, but several lifestyle factors can make your blood sugar take a dangerous dip, even if you aren’t diabetic:

  • eating infrequently or irregularly
  • skipping a meal
  • exercising more than usual (which uses up glucose)
  • severe morning sickness
  • drinking alcohol
  • an eating disorder
  • not consuming enough blood-sugar-stabilizing foods

If you’re diabetic, your medication could be too effective at lowering your blood sugar. This is the most common reason for hypoglycemic episodes during pregnancy, and your doctor can resolve this by modifying your dosage.

Other medications may affect glucose levels, too. These include:

  • sulfa drugs
  • salicylates, or pain relievers, like aspirin (which most doctors don’t recommend during pregnancy)
  • pentamidine
  • quinine

Some medical conditions may cause hypoglycemia. These disorders are rare, but they can impact a developing baby so diagnosis and treatment is important:

  • a pancreatic tumor
  • organ failure
  • hormone imbalances (cortisol and glucagon, in particular)
  • certain enzyme deficiencies
  • recent stomach surgery

The DL on diabetes and hypoglycemia

Having type 1, type 2, or gestational diabetes increases your chances of hypoglycemia, compared to someone who is pregnant but not diabetic. This is because your already fluctuating insulin levels have a new factor to deal with: pregnancy hormones. (Yay, hormones!)

Even if you aren’t taking medication for your diabetes, you may still experience hypoglycemic episodes. For this reason, you should eat a balanced diet and carefully monitor your blood sugar throughout your pregnancy.

Signs of hypoglycemia during pregnancy are similar to what a non-pregnant person with low blood sugar may experience (i.e. hangry). Symptoms may include:

  • anxiety
  • blurred vision
  • difficulty thinking clearly
  • exhaustion
  • headache
  • irregular heartbeat or heart palpitations
  • light-headedness
  • moodiness or irritation
  • nausea or vomiting
  • pale skin
  • shaking
  • sweating
  • tingling around the mouth

Once your blood sugar rises, these conditions typically disappear. The symptoms of severe hypoglycemia can be even more serious if left untreated. It can cause seizures, convulsions, or even loss of consciousness.

Talk to your doctor right away if you notice any symptoms of low blood sugar. They will conduct blood glucose tests to determine the cause and whether you’re experiencing ongoing hypoglycemia.

They may also prescribe a blood sugar monitoring kit and ask you to take several readings a day and record them.

If your blood sugar feels low, don’t ignore your symptoms or open a bag of something sugary.

Instead, take the following steps:

  1. Sit or lie down in a safe place. If you’re driving, pull over.
  2. Eat or drink 15 grams of carbohydrates, like 4 ounces of regular fruit juice (not diet or reduced sugar), half a can of regular soda, one tablespoon of sugar or honey, or four glucose tablets.
  3. Notify your doctor.

Treatment for hypoglycemia varies if you have diabetes, but your doctor will likely adjust your medication to stabilize your glucose levels. They may also recommend diet and exercise changes.

In rare instances of severe hypoglycemia, you may be prescribed a glucagon kit containing a synthetic form of glucagon and a sterile syringe. When injected, the hormone stimulates the liver to release stored glucose. This raises your blood sugar quickly.

Reducing your risks

Whether or not you’re diabetic, there are several measures you can take to help reduce the risk of a hypoglycemic episode. Unfortunately, giving in to your most indulgent pregnancy cravings isn’t one of them:

  • Eat small, well-balanced meals every 3 to 4 hours to help keep your blood sugar levels steady.
  • Keep a snack at your bedside — you fast while sleeping, so it’s important to keep something nearby in case you wake during the night (or, for first thing in the morning).
  • Exercise at a consistent level, unless your doctor advises against it (excessive exercise can affect your blood sugar for up to 24 hours).

Don’t sugar-coat it

Pregnancy hormones have minds of their own, but a balanced diet can help you manage your glucose levels.

First, put that diaper bag to use a little early and fill it with snacks. This way you’ll be able to quickly give your blood sugar a little boost, should you feel lightheaded or shaky.

The following snacks have about 15 grams of carbohydrates each — the ideal amount for rebalancing glucose levels — and make for quick, purse-friendly fixes:

  • a few prunes
  • an apple, banana, or orange
  • grapes (approximately 15)
  • half a bagel
  • half a cup of granola
  • 2 tablespoons of raisins

In addition to keeping snacks on hand, be mindful of your food combinations. Aim for a variety of fruits, veggies, and lean protein. Spread your carb intake throughout the day and try to eat any sweets with a meal.

Try limiting your intake of high-sugar foods. By causing a rapid increase in blood glucose, sugar also increases insulin, which can ultimately cause your blood glucose to drop once more.

If you’re diabetic, eating the right amount of food at the right time, moderating your exercise, and avoiding taking too much insulin or other diabetes medications can help prevent a hypoglycemic episode.

Should you begin to feel symptoms of low blood sugar, follow the 15-15 Rule:

  • Eat or drink 15 grams of carbohydrates.
  • Wait 15 minutes, then check your blood glucose levels.
  • If your blood sugar is still less than 60 mg/dL, consume another 15 grams of carbs.
  • If it’s more than 45 minutes until your next meal, eat a piece of bread with some sort of protein.
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Feeling woozy or fatigued can be uncomfortable, but it’s important to not overeat in an attempt to feel better. This could cause your blood sugar levels to rise too quickly.

If the symptoms of hypoglycemia sound familiar, don’t panic — mild or occasional episodes are unlikely to harm your baby. In most cases, adjusting your diet or medication can help keep low blood sugar at bay.

In the instance of severe hypoglycemia, it’s possible that seizures, coma, or even death may occur. Hospitalization may be required. There’s also a chance that your baby may be born with or develop hypoglycemia shortly after birth and require close monitoring.

For some women, the combination of diabetes and low blood sugar can make labor more difficult. Their baby may be unusually large, which can increase the risk of injury in the case of a vaginal delivery.

Hypoglycemia is far more common in diabetic pregnancies than non-diabetic pregnancies.

One study found that 45 percent of women with type 1 diabetes experienced episodes of hypoglycemia; another found that 23 percent of women with type 1 diabetes had at least one severe hypoglycemic episode during their pregnancy.

Hypoglycemia happens for many reasons. Even something as simple as skipping a meal can lead to an episode. Other conditions may increase your risk, too.

These include:

  • being in your first trimester, when nausea and vomiting are more likely to take place (One study found that women with type 1 diabetes experienced severe hypoglycemia three times more frequently in the first trimester than before their pregnancy.)
  • having hypoglycemic episodes prior to pregnancy
  • sickness or a lack of appetite that affects your food intake
  • malnourishment

Once your baby has arrived and the pregnancy hormones have subsided, your blood sugar levels will likely return to normal.

Most women with gestational diabetes notice their symptoms disappear within a few weeks of giving birth. If you do develop gestational diabetes, there’s an increased likelihood of developing the condition during future pregnancies. You also have a higher likelihood of developing type 2 diabetes later in life.

There’s no foolproof way of preventing hypoglycemia during pregnancy, but you can take steps to reduce the risk — even if you have diabetes. Eating regularly, recognizing the signs of low blood sugar, and keeping your doctor informed can help make sure you and your baby remain in good health.