What to Know About Reactive Hypoglycemia and Pregnancy

Reactive hypoglycemia (reactive low blood sugar) can occur during pregnancy due to hormonal changes. Eating small, regular, nutritious meals or snacks can help stabilize your blood sugar.

During pregnancy, your body goes through a range of changes. This includes how your body processes food and manages blood sugar.

For some, these shifts can lead to reactive hypoglycemia. Also called postprandial (post-meal) hypoglycemia , it’s a condition where blood glucose (sugar) levels drop after you’ve eaten.

Read on to learn more about why it happens and how to manage the condition.

Understanding reactive hypoglycemia in pregnancy

It’s normal for blood sugar levels to fluctuate throughout the day — but reactive hypoglycemia happens when blood sugar levels drop excessively within a few hours after eating. While this is most common in people with diabetes, it can also happen to those who don’t have it.

This may occur during pregnancy due to a combination of factors, including :

• Changes in how the body regulates glucose: During pregnancy, the placenta makes hormones that can lead to insulin resistance.
• A spike in insulin production: This helps support the growing baby. To counteract the insulin resistance, your body produces more insulin.
• Changes in how the body responds to insulin: During pregnancy, your body produces human placental lactogen , which can make cells less responsive to insulin. Even with the boost in insulin, lactogen can cause issues with blood sugar regulation. The pregnant body may essentially overcompensate, which can lead to a corresponding drop in blood sugar levels.

It’s important to note that reactive hypoglycemia during pregnancy has been associated with some negative complications for babies. These include :

• lower birth weights
• higher rates of admission to the neonatal intensive care unit (NICU)
• increased rates of appearance, pulse, grimace, activity, and respiration (APGAR) scores below 7, which signifies that the baby may need medical attention

These potential issues can be remedied by taking measures to keep blood sugar under control and ensure a healthy pregnancy.

Causes and risk factors

Simply being pregnant raises your risk of hypoglycemia. However, if you already have diabetes when you get pregnant, you may be at a particularly high risk.

Several factors can raise one’s risk of getting reactive hypoglycemia during pregnancy, including:

• having diabetes (type 1, 2, or gestational)
• being in the first trimester of pregnancy
• a history of previous hypoglycemic episodes
• infrequent or inadequate eating habits
• excess exercise with insufficient food for fuel
• diabetes medications that lower blood sugar too much
• having certain metabolic diseases
• having a BMI classified as overweight or obese
• having a history of certain surgeries, such as gastric bypass

Symptoms of reactive hypoglycemia

Symptoms of reactive hypoglycemia are typically recognizable within a few hours of finishing a meal. They may include :

• anxiety
• irritability
• nervousness
• sweating
• shaking
• dizziness
• lightheadedness
• rapid heart rate
• blurred vision
• hunger
• fatigue

Severe hypoglycemia can lead to more dangerous symptoms such as:

• seizures
• convulsions
• loss of consciousness

Dietary changes to manage blood sugar

Dietary strategies for managing your blood sugar levels include:

• eating small, frequent meals
• reducing your consumption of refined and processed sugars
• spreading your carbohydrates throughout the day
• eating balanced meals that contain a combination of carbs, proteins, and fats

You can also make adjustments to what you eat. Aim to include the following in your diet:

• complex carbohydrates like whole grain bread, oatmeal, and sweet potatoes
• lean protein sources like eggs, meat, and fish
• high fiber foods like fruits, vegetables, and beans
• foods with a low glycemic index , like green vegetables, beans, and legumes

More information about following a hypoglycemia diet .

Home care and lifestyle changes

It’s a good idea to have a blood glucose test on hand in case of an emergency.

If you notice any symptoms of low blood sugar, such as dizziness, irritability, or shakiness, there are steps you can immediately take to stabilize your levels, including:

• Follow the Rule of 15: This involves consuming 15 grams (g) of simple carbs, such as a small glass of juice or 1 tbsp of honey. Wait 15 minutes, and then re-check your blood sugar. If it’s still below 70 mg/dL, repeat.
• Eat a small, nutritious snack: Once your levels stabilize, eating a balanced snack containing carbs, protein, and fat can prevent another drop.

In general, other safe practices include:

• eating small, regular, well-balanced meals and snacks
• letting your doctor know about any hypoglycemic episodes
• always keeping quick-acting carbs on hand with you, just in case

When to contact a doctor

If you suspect you’re experiencing hypoglycemia during pregnancy, it’s essential to consult your doctor to avoid any negative health outcomes for you or your baby. Your doctor may recommend:

• regular blood sugar monitoring
• a mixed-meal tolerance test
• adjustments to your diet, meal timing, or exercise routine
• potentially, changes in medication (such as diabetes medication)

When levels drop dangerously low

Remember that very low blood sugar is considered a medical emergency.  If you ever feel severely lightheaded, dizzy, or like you may pass out, consume glucagon (if applicable) or 15 g of simple carbs (like 5 oz of juice or 1 tbsp of honey) immediately. If symptoms don’t resolve within about a minute, contact emergency services.

Learn more about emergency treatments for low blood sugar .

The bottom line

There’s an increased risk of reactive hypoglycemia during pregnancy, especially among women who already have diabetes. Without stabilizing these levels, there’s a higher risk of birth complications for the baby.

By taking measures to regulate blood sugar levels, however, including consuming small, regular snacks, you can ensure a healthier pregnancy for both mother and baby.

If you experience issues like lightheadedness, dizziness, or irritability, talk with your doctor about a potential low blood sugar diagnosis.