Pregnancy with Type 2 Diabetes: Everything You Need to Know

As if pregnancy isn’t challenging enough, juggling type 2 diabetes during the pursuit of motherhood comes with its own unique set of responsibilities, pressures, and stressors.

In this article, we’ll discuss everything you need to know about pregnancy with type 2 diabetes, from preparing for pregnancy to your postpartum self-care.

Your A1c before getting pregnant

You likely already know how important it is for a woman with diabetes to manage her blood sugars carefully during pregnancy, but it’s actually just as important before you become pregnant, too.

In fact, your blood sugar levels and A1c during the 6 months prior to becoming pregnant can have a tremendous impact on both your ability to become pregnant and on the health of your baby.

“Consistently high blood sugar levels can actually impact your ability to conceive,” explains Jennifer Smith, RD, CDE, and co-author of Pregnancy with Type 1 Diabetes.

(Of course, not all pregnancies are planned, which means you’ll want to make blood sugar management priority #1 as soon as you do learn that you are pregnant.)

The American Diabetes Association recommends achieving an A1c level below 7.0 percent before conceiving. This will improve your fertility, decrease your risk of miscarriage, and reduce the risk of birth defects developing in your baby.

“High blood sugars during the 6 months before you get pregnant increases the risk of birth defects in your baby because high blood sugars impact everything in your body — your eggs, ovulation, and entire reproductive system,” explains Smith.

Focusing on improved blood sugar management before getting pregnant is truly your first task as a mother with diabetes. 

Meet with a high-risk OBGYN team before getting pregnant

The term “high-risk” has such negative connotations but for women with diabetes, this is an essential resource for your pregnancy and the wellbeing of your baby.

A high-risk OBGYN team (also referred to as Maternal-Fetal Medicine – MFM) simply has in-depth training and knowledge on supporting a woman with additional health conditions during pregnancy.

Women with type 1 and type 2 diabetes should highly consider using a high-risk OBGYN team rather than a standard OBGYN office during pregnancy because even if your diabetes is well-managed, this specialized team of doctors will better understand the challenges you face.

If you’re able to plan your pregnancy, schedule an appointment with a high-risk OBGYN office in your area before getting pregnant so they can help you prepare for things, like ensuring your current medication list is safe to continue during pregnancy!

Medications and current health before getting pregnant

Even if your type 2 diabetes doesn’t stop you from living a full life, it’s important to remember that your body still has a unique set of challenges that can impact your pregnancy.

This means that both your current medications and your current health — including any diabetes complications or additional conditions — need to be discussed before you try to conceive. 

Diabetes medications

Certain medications you may have been using for years to manage your type 2 diabetes may not actually be considered safe to use during pregnancy. 

The reason some are easily deemed safe while others are not is based on whether or not the medication “crosses the placenta” directly into the baby’s bloodstream, as explained by the American Diabetes Association.

Sometimes it’s because it simply hasn’t been studied yet, so it cannot be deemed by the FDA (Food and Drug Administration) as safe to use during pregnancy. But in many cases, the drug may be known as a risk to the baby or increase the chances of birth defects or complications.

Medications are divided into these categories regarding safety during pregnancy:

Category A: “Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).”

Example: Some types of insulin

Category B: “Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.”

Example: metformin commonly used in type 2 diabetes management

Category C: “Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant the use of the drug in pregnant women despite potential risks.”

Example: gabapentin commonly used for diabetic neuropathy

Category D: “There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant the use of the drug in pregnant women despite potential risks.”

Category X: “Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in the use of the drug in pregnant women clearly outweigh potential benefits.”

*Read more about the FDA’s guide to drug approval during pregnancy.

Oral medications

Many oral diabetes medications are simply too new to have been studied for safety during pregnancy. Metformin (Glucophage) and glyburide (Glynase, Diabeta) are both category B drugs which means they are likely safe to continue taking but haven’t been studied in pregnant humans, only pregnant animals.

Non-insulin injectable medications

These drugs simply have not been studied carefully during pregnancy so they aren’t going to be deemed “safe” to use, but your diabetes and OBGYN healthcare team will help you determine if you should continue taking them or not.

Insulin

Most types of insulin are deemed safe, even if it hasn’t been studied specifically during pregnancy, because insulin does not cross the placenta.

You should also anticipate possibly needing to start insulin during the 2nd or 3rd trimesters of your pregnancy even if you don’t already take it because of the severe insulin resistance that develops due to increased hormone levels.

If you do already take insulin, your doses will change throughout your pregnancy.

“If you currently take insulin to manage your type 2 diabetes, you’ll likely need to make several adjustments between week-16 and when you give birth because of rising hormone levels,” explains Jenny Smith. 

Working closely with your high-risk OB-GYN team, your CDE, or a pregnancy coach will be critical to ensuring you’re making the insulin adjustments you and your baby need.

Current health

Pregnancy can be very stressful on the body in a variety of ways. If you’ve lived with type 2 diabetes for a long time you may have early or well-established signs of complications like diabetic retinopathy.

Pregnancy increases the pressure on your blood vessels which means it can actually worsen pre-existing retinopathy. If you have already been diagnosed with retinopathy, you’ll want to meet with your eye doctor prior to conceiving to discuss the risks and any precautions you can take to lessen the impact of pregnancy on your eye health.

Any woman with any type of diabetes should have their eyes thoroughly examined prior to becoming pregnant.

Checking your blood sugar during pregnancy with type 2 diabetes

In addition to having your A1c level measured frequently during pregnancy, this is a time in your life when you should absolutely be checking your blood sugar at home several times a day.

The American College of Obstetricians and Gynecologists (ACOG) recommends the following blood sugar targets during pregnancy:

• fasting (when you wakeup): <90 mg/dL
• before a meal: <105 mg/dL
• 1 hour after eating: <130–140 mg/dL
• 2 hours after eating: <120 mg/dL

Even if you don’t check your blood sugar regularly prior to pregnancy, using a glucose meter for these 9 months will help you see how your nutrition, medications, and exercise are helping you keep your blood sugar levels in the safest range possible during your pregnancy.

Nutrition during pregnancy

You do not have to eat perfectly throughout your pregnancy. However, women with diabetes need to be incredibly more cautious and thoughtful when making choices around food.

The first nutrition goal for any woman — and especially a woman with diabetes — during pregnancy is to eat a diet of mostly whole foods. Real food rather than highly processed food is going to give both you and baby what is needed most: vitamins, minerals, fiber, and high-quality fat, protein, and carbohydrates.

When it comes to cravings, let diabetes be your motivation to not give in to every urge or craving. Instead, make room for one indulgence per day or every other day by eating a diet that is mostly healthy throughout the rest of the day. 

As a woman with diabetes, you and your baby simply cannot afford to indulge on cravings for loaves of bread, daily pizza, or entire cartons of ice cream.

“Remember, the more excess weight you gain beyond the recommended 25 to 30 pounds during pregnancy, the more you’ll struggle with insulin resistance during and after your pregnancy,” reminds Smith. 

Aim for a goal of 80/20: 80 percent healthy, 20 percent less-than-healthy.

Daily physical activity

It ought to be a prescription for every woman with any type of diabetes — or perhaps every woman who is pregnant even if they don’t have diabetes: walking every day during pregnancy.

While you may still feel like jogging or lifting weights in the earlier stages of pregnancy, there may be a point at which the extra jostling is quite, well, unbearable during the 2nd or 3rd trimesters.

Walking every day for at least 30 minutes during those later stages of pregnancy will do you and your baby so much good:

• Combat insulin resistance
• Naturally lower blood sugar levels
• Encourage healthy blood flow and circulation
• Reduce your risk of pre-eclampsia
• Improve your mood and decrease stress

If you do take insulin, you may find you’ll want to cut back the insulin dose for that meal if you plan to walk afterward. (Remember to always carry fast-acting glucose with you for low blood sugars!)

It doesn’t have to be a marathon! Just get up and go for a walk.

Risks associated with pregnancy and type 2 diabetes

There are several well-established risks that come with pregnancy and type 2 diabetes, that can impact both you and your baby. Let’s take a look.

Macrosomia: a very “chubby” baby

If your blood sugars are persistently high during your pregnancy, and your A1c is over 7 percent, you can anticipate that your baby will likely be “chubbier” than average. The more sugar there is in your blood, the more sugar your baby is getting from your blood, which leads to a fatty baby.

Your baby’s weight will be measured weekly during the last trimester of your pregnancy. These are estimates, and they aren’t 100 percent accurate, but they give your healthcare team a general idea of how much weight your baby is gaining and it’s likely size at birth.

While there’s actually nothing cuter than a chubby baby, “macrosomia” due to high blood sugar levels can lead to other potential complications during and after childbirth.

Low blood sugar (hypoglycemia) at birth

Once the umbilical cord is cut and your baby is no longer receiving nutrients from you — the high sugar source — it can take up to 12 hours for its own insulin production to lessen, which means your baby can experience mild to moderate low blood sugars during the hours after being born.

Your baby’s blood sugar will be tested several times after being born to determine if they need a bottle of glucose or if breastfeeding immediately will be adequate.

Shoulder dystocia 

This is when your baby’s shoulder area gets “stuck” in the vaginal canal during a vaginal birth largely due to macrosomia. It can lead to a variety of complications and injuries for both mother and baby, including postpartum hemorrhaging in the mother, and bone fractures or nerve damage in the baby.

High-risk of needing a cesarean section

An adorably chubby baby can also mean he or she is simply too big to deliver safely vaginally. If you have retinopathy, a c-section will also be recommended. While this can be disappointing for you as the mother, it is sometimes the only safe option for you and your baby. 

Induction at 39 weeks 

Research has shown an increased risk of stillbirth in women with any type of diabetes if they don’t deliver by 39 weeks pregnant. For this reason, many women are induced or scheduled for a C-section by the 39-week mark.

Jaundice 

Jaundice is a very common medical condition in babies born earlier than 39 weeks, which is a highly likely event for a woman with type 2 diabetes. 

Preeclampsia & high blood pressure

“Preeclampsia is when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly,” explains the March of Dimes. 

Preeclampsia is very dangerous and can be life-threatening, so you should keep a close eye out for symptoms throughout your pregnancy, especially in the later months.

Signs of preeclampsia include:

• Presence of protein in your urine
• Changes in vision and severe headaches
• High blood pressure 

For some, preeclampsia can be managed with medication and bed rest, but for more severe cases, it can require staying in the hospital for 24-hour observation until it’s safe to induce labor or deliver via C-section.

Postpartum depression

Postpartum depression is also much higher in mothers with any type of diabetes, inevitably because we face more daily challenges on top of adjusting to motherhood.

If you’re feeling overwhelmed by feelings of sadness, anger, anxiety, stress, or fear, talk to your healthcare team immediately.

There are many options available to help you work through postpartum depression — and sometimes simply putting a label to it helps the most.

Breastfeeding with type 2 diabetes

Women with type 2 diabetes can absolutely breastfeed their babies but do keep in mind that persistently high blood sugars will make it harder for your body to successfully produce breastmilk.

Let your breastfeeding goals be a motivation to continue taking good care of your diabetes even after your baby is born.

It’s also important to remember that some medications can pass into your breastmilk, so you should still discuss every medication you plan on taking with your healthcare team before starting it. 

Do the best you can without expecting perfection

Pregnancy is full of challenges and adding type 2 diabetes to that list of challenges isn’t easy. The most important thing to remember is that women with diabetes give birth to healthy babies every single day!

You simply need to show up and do the best you can — sometimes your best will look perfect on paper, and sometimes it won’t. Don’t beat yourself up for the rougher days, just brush-off and keep trying!