How to have a successful pregnancy with type 2 diabetes

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Having type 2 diabetes can increase the risk of pregnancy complications for the pregnant person and the fetus.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) explains that the hormonal changes that occur during pregnancy can affect a person’s blood glucose levels (BGLs), which can worsen preexisting diabetes-related illnesses.

High BGLs during pregnancy may also increase the risk of the following:

• Preeclampsia: A serious and potentially life threatening condition, with signs including high blood pressure and excess protein in the urine.
• Miscarriage and stillbirth: A miscarriage is the loss of the fetus before 20 weeks of pregnancy, while stillbirth is the loss of a fetus at or after 20 weeks of pregnancy.
• Birth defects: Fetuses exposed to high levels of circulating blood glucose during the first 8 weeks of pregnancy are at increased risk of developing birth defects.

A fetus’s organs begin developing during the first 8 weeks of pregnancy, and high BGLs during this period can increase the risk of birth abnormalities, such as heart, brain, and spine problems.

High BGLs during pregnancy can also increase the risk of miscarriage and stillbirth.

The Centers for Disease Control and Prevention (CDC) outlines some additional diabetes complications that can affect newborn babies. These include:

• premature birth, which may cause complications, such as:
  • heart problems
  • intestinal problems
  • breathing issues
  • bleeding in the brain
  • vision problems
• increased birth weight, which may complicate delivery
• low BGLs immediately after birth

People who want to become pregnant should aim to get their BGLs within a healthy range first and then, maintain these levels throughout their pregnancy. Doing so should decrease the risk of diabetes-related complications for the pregnant person and the fetus.

Before pregnancy, a person with type 2 diabetes should prepare in the following ways.

• Get a full health check before the pregnancy.
• Work with a registered dietitian, and follow an appropriate meal plan.
• Engage in physical activity for at least 30 minutes per day 5 days per week.
• Take diabetes medications as a doctor advises.
• Take a minimum dose of 400 micrograms (mcg) of folic acid per day at least a month before pregnancy, and increase this to 600 mcg daily during pregnancy.
• Quit smoking.
• Avoid alcohol.

The NIDDK explains that a person’s daily blood glucose targets may change before and during pregnancy.

The recommended daily blood glucose targets for people with diabetes who are pregnant are as follows:

• Before meals, at bedtime, and overnight: 90 milligrams per deciliter (mg/dL) or less.
• One hour after eating: 130 to 140 mg/dL or less.
• Two hours after eating: 120 mg/dL or less.

However, a person should talk with a diabetes healthcare team for advice regarding their specific blood glucose targets.

Doctors may also recommend daily urine testing throughout the pregnancy to assess a person’s ketone levels. Ketones are chemicals the body produces when it uses stored fats as a fuel source instead of glucose. The medical term for this process is “ketosis,” and it can be harmful both to the pregnant person and the fetus.

People with diabetes who are planning to become pregnant can talk with an obstetrician-gynecologist (OB-GYN) or doctor for further information and guidance. Doing so can decrease the risk of problems later on.

According to the American College of Obstetricians and Gynecologists (ACOG), getting the right support before pregnancy can help a person:

• learn about and discuss treatment options for any existing diabetes complications, such as:
  • high blood pressure
  • heart disease
  • kidney disease
  • eye problems
• discuss appropriate weight loss methods, if necessary
• discuss medication dosages and the use of prenatal vitamins

A person can also talk with an OB-GYN or doctor about any other diabetes or pregnancy-related concerns they have.

Type 2 diabetes can increase the risk of complications during pregnancy, such as miscarriage, preeclampsia, and birth abnormalities. People can take steps before and during pregnancy to keep their blood glucose levels within a healthy range to reduce the risk of complications.

Steps to take before pregnancy include getting a full health check, following an appropriate meal plan, and taking any necessary medications or supplements. During pregnancy, a person should follow the following routine: blood glucose monitoring and daily urine testing to check ketone levels.

A person can talk with an obstetrician-gynecologist or doctor for more advice about how to reduce the risk of diabetes-related pregnancy complications. Doctors can discuss appropriate lifestyle changes and treatment options and address any other concerns a person may have.