Type 2 Diabetes and Pregnancy: How to Have the Healthiest Possible Pregnancy When You Have Type 2 Diabetes

Navigating pregnancy can be overwhelming—especially when you’re dealing with an added complication like type 2 diabetes. But there’s no need to panic: “Diabetes can be managed and the risks can be minimized,” says Christine Dennis, a certified registered nurse practitioner specializing in maternal-fetal medicine and diabetes in pregnancy.

Here’s everything you need to know to have a healthy pregnancy—and a healthy baby—when you have type 2 diabetes.

Preexisting diabetes vs. gestational diabetes

About 1 to 2 percent of pregnant women have preexisting diabetes, according to the March of Dimes, and this number has increased in recent years. These women might know they have diabetes pre-conception, but Dennis says she sees “a good number” of cases in which women learn they have type 2 diabetes during pregnancy.

Confusing the conversation: About 10 percent of pregnant women will develop gestational diabetes, according to the Centers for Disease Control and Prevention. Gestational diabetes, which is caused by placental hormones, is typically diagnosed in the second or third trimester, following a standard glucose screening test, which is administered between 24 and 28 weeks of pregnancy. If it wasn’t caught pre-pregnancy, preexisting diabetes is often diagnosed in the first trimester.

What are the risks of diabetes in pregnancy?

If you have type 2 diabetes and are considering getting pregnant, your doctor will likely administer a hemoglobin A1c (HbA1c) blood test, which will reflect your average blood-sugar levels over the past two to three months, and may recommend steps to reduce your HbA1c. “The higher the A1c, the higher the risk [to the pregnancy],” adds Dennis.

If you’ve been diagnosed with type 2 diabetes and are already pregnant, the most important thing you can do is keep your blood-sugar levels in check. “For anyone with preexisting diabetes, the one thing that we know with a hundred percent certainty is that if they’re able to control their blood sugar, the risks of adverse outcomes—things like stillbirth and birth defects, among other complications—are reduced almost to the level of someone in the general population,” says Anushka Chelliah, M.D., board-certified maternal-fetal medicine specialist at Pediatrix Medical Group in Florida.

Both experts emphasize that it’s the overall trend in your blood-sugar levels that matters. “Women tend to really beat themselves up if they have a high blood-sugar reading, but I try to deemphasize the severity of one individual high-blood sugar reading,” Dennis says. An occasional spike in your blood sugar “won’t have a major impact—or any impact—on the health and well-being of the baby. It’s the repetitive, recurrent elevations over the duration of the pregnancy” that are problematic.

If your blood-sugar levels go uncontrolled during pregnancy, the risks can be serious.

Risks for the baby

• macrosomia (large baby): High blood sugar can cause excessive growth, which can lead to increased risk of c-section, prolonged labor, and increased risk of birth injuries.
• hypoglycemia (low blood sugar): Babies born to moms with uncontrolled diabetes are at greater risk of prolonged hospital stays due to issues regulating their own blood sugar and electrolytes.
• birth defects: Women with preexisting diabetes have a higher risk of having babies with neural-tube and heart defects.
• preterm birth or stillbirth: In rare cases, complications from uncontrolled diabetes can lead to early delivery or stillbirth.
• breathing problems
• greater risk of obesity and type 2 diabetes

Risks for the mother

• preeclampsia: Diabetes increases the risk of hypertensive disorders, including high blood pressure and preeclampsia.
• worsening of preexisting health problems: Pregnancy can exacerbate preexisting complications of diabetes, including like kidney disease, neuropathy, and retinopathy. “If someone has type 1 or type 2 diabetes, they are usually followed pretty carefully by their endocrinologists and by specialized doctors,” says Chelliah.

How to have the healthiest possible pregnancy with T2D

Having a handle on your health pre-pregnancy is the best way to get your pregnancy off to a good start. This is true of all pregnancies, but it’s especially important for patients with type 2 diabetes. Here are the steps you should take before, during, and after pregnancy:

Before getting pregnant

Assemble your care team. In addition to your OB-GYN, you may also work with a maternal-fetal medicine specialist, a doctor who specializes in high-risk pregnancy care. “This type of physician will not only be able to help manage diabetes during pregnancy, but also help manage the specialized surveillance of the fetus during the pregnancy including more detailed anatomy ultrasounds, detailed studies of the baby’s heart, and close surveillance of the growth of the baby as you get into the third trimester,” says Chelliah. If you have preexisting type 2 diabetes, you’ll likely also work with your endocrinologist, dietitian and/or diabetes educator during pregnancy.