Maternal Hypoglycemia And Insulin Exposure In Gestational Diabetes: A Systematic Review Of Fetal And Neonatal Outcomes

Abstract

Background: Gestational diabetes mellitus (GDM) is commonly managed with insulin therapy when lifestyle measures fail. While insulin improves glycemic control, it may increase the risk of maternal hypoglycemia, which could influence fetal and neonatal outcomes.

Objective:To evaluate the association between maternal hypoglycemia and insulin exposure in GDM with fetal and neonatal outcomes.

Methods: A systematic review was conducted following PRISMA guidelines. Databases (PubMed, Scopus, Web of Science, Cochrane Library) were searched from inception to January 2025. Clinical studies assessing maternal hypoglycemia and/or insulin exposure in GDM with reported fetal or neonatal outcomes were included.

Results: Multiple eligible clinical studies were identified. Evidence suggests that maternal hypoglycemia may be associated with adverse outcomes such as neonatal hypoglycemia, low birth weight, and increased NICU admission, although findings remain inconsistent. Insulin therapy improves glycemic control but shows variable associations with neonatal outcomes depending on glycemic variability and dosing strategies.

Conclusion: Maternal hypoglycemia in GDM may impact fetal and neonatal outcomes; however, evidence remains heterogeneous. Careful glycemic monitoring and individualized insulin therapy are essential.