If you have type 2 diabetes and are pregnant or planning to become pregnant, it's important to be aware of potential risks and complications. Pregnancy with type 2 diabetes comes with challenges, but understanding what to expect and how to manage your condition can make a big difference. This article discusses important information, highlighting why it’s essential to keep your blood sugar under control. You’ll find tips to help you stay healthy during pregnancy, making this time safer for both you and your baby.

To help you prepare for a healthy pregnancy, we asked Dr. Avni Vora, an endocrinologist from Northwestern Medicine, to share her knowledge. Dr. Vora supports people with type 1 diabetes, type 2 diabetes, and gestational diabetes before, during, and after pregnancy.

​Keep reading for six facts about type 2 diabetes and pregnancy.

1. Managing Your Blood Sugar Is Essential

High blood sugar, also called hyperglycemia, can create health problems for you and your baby. Dr. Vora said this is true for people with any type of diabetes.

“When you have high blood sugars during pregnancy, your baby makes insulin in response to those blood sugars,” Dr. Vora said. “And that insulin can make the baby gain weight, leading to a baby who is larger than normal, which can make delivery more difficult.”

High blood sugar can also affect the quality of the placenta, an organ that provides oxygen and nutrients to the baby and removes waste from the baby’s blood. Dr. Vora explained that the baby might not get the necessary nutrients if the placenta is not working well.

Other potential complications include increased risk of a miscarriage or stillbirth, increased need for a cesarean section (C-section) delivery, high blood pressure (preeclampsia), and worsening of a diabetes-related eye disease called retinopathy. Glucose control is also essential on delivery day.

“It’s really important to have strict blood sugar control at the time of delivery,” Dr. Vora said. “If a mother’s blood sugars are high, the baby makes insulin in response. After delivery, the baby is producing extra insulin but is not getting sugar from the mother anymore. This can lead to the baby actually having low blood sugar after delivery.” Low blood sugar is called hypoglycemia, and brain injury and seizures are two potential complications of hypoglycemia in newborns.

Don’t let these potential risks and complications keep you from trying to conceive. Just know your risk factors and discuss your concerns with your health care team so they can help you prepare.

2. You Might Have Trouble Conceiving

Some people with type 2 diabetes have trouble getting pregnant, so it’s worth discussing with your health care provider. Dr. Vora said this could be due to a link between type 2 diabetes and polycystic ovary syndrome (PCOS), one of the most common causes of female infertility. According to the Centers for Disease Control and Prevention (CDC), more than 50 percent of people with PCOS develop type 2 diabetes by the time they are 40 years old.

“We still don’t totally understand it, but we know that PCOS is associated with metabolic issues. People with PCOS tend to have more insulin resistance, and PCOS can potentially cause irregular cycles and loss of ovulation,” Dr. Vora said. “So, that can be a contributing factor. But PCOS is very common, and not everybody with PCOS has trouble getting pregnant.”

Age is another factor that could affect your ability to conceive if you have type 2 diabetes.

“Because type 2 diabetes occurs later in life, many of those with type 2 diabetes trying to get pregnant are in their late 30s or early 40s,” Dr. Vora said. “We do see increased insulin resistance and a higher risk of pregnancy complications with age.”

3. You Can Prepare for Pregnancy

Before trying to conceive, Dr. Vora recommends taking steps to prepare. If you’re already pregnant, ask your doctor what you can start doing now.

Eye Exam

Ask your health care provider for an eye exam before you start trying to get pregnant. Diabetic retinopathy can become worse during pregnancy and, if severe, can lead to blindness. If you have retinopathy, Dr. Vora suggests getting a thorough checkup of your eyes every trimester.

Medication Changes

Dr. Vora recommends preparing for pregnancy by controlling your blood sugar levels before you conceive. Insulin resistance during pregnancy can make this more challenging. Ask your doctor for a hemoglobin A1c (HbA1c) test, which measures your average blood sugar over the last two to three months.

“I think the first step, at least when it comes to diabetes, is trying to optimize your blood sugar control as much as possible before you try to get pregnant,” Dr. Vora said. “If somebody comes to me with a high A1c, I say, ‘Let’s first work on getting your blood sugars under better control before you try to get pregnant.’”

You might also need to adjust your medications before pregnancy.

“The blood sugar goals for pregnancy are much lower than for people with diabetes who are not pregnant,” Dr. Vora said. “We are aiming for very tight control during pregnancy to reduce the risk of complications. We try to adjust the medicine pre-pregnancy to try to get toward those goals so that when you do get pregnant, it’s not as hard to adjust.”

4. Pregnancy Can Change Your Diabetes Care Plan

If you have lived with type 2 diabetes for a while, you and your health care provider have likely found ways to manage it. Pregnancy can change your treatment plan.

Treatment Changes

Dr. Vora said when someone with type 2 diabetes comes to see her after getting pregnant, she often starts them on an oral medication called metformin. It’s one of the only diabetes medications tested in pregnant people. Most of the other medications for type 2 diabetes have not been tested to see if they are safe to take during pregnancy. Dr. Vora also tells her pregnant patients that they will likely need insulin at some point.

“A lot of women with type 2 diabetes end up needing insulin during pregnancy because of the severe increase in insulin resistance,” Dr. Vora said. “And people with type 2 diabetes already have a lot of insulin resistance. Adding pregnancy hormones that increase insulin resistance can make it very challenging to manage their blood sugars during pregnancy.”

Your Care Team

In addition to an endocrinologist — a doctor who specializes in treating hormone-related health issues like diabetes — you’ll need an obstetrician. An obstetrician is a doctor who cares for pregnant people and delivers babies. In early pregnancy, Dr. Vora said you will likely see your obstetrician monthly for routine appointments. These visits will become more frequent as you approach your delivery date.

Most people with diabetes also see a maternal-fetal medicine specialist. These providers support people through high-risk pregnancies, including those complicated by diabetes. In some cases, a maternal-fetal medicine specialist can manage your diabetes and obstetrics care. If so, you might see your endocrinologist less during this time.

“For me, it’s a mix,” Dr. Vora said. “If I have a patient who has a maternal-fetal medicine specialist that wants to manage their diabetes during pregnancy, I say, ‘OK, come back and see me after you deliver.’ I have other patients who stay with me throughout the whole pregnancy, and I typically see them every four to six weeks.”

Some people find it helpful to get help from a diabetes educator. They can teach you how to manage your blood sugar levels, choose healthier foods, and understand your medications better, making it easier to manage your diabetes.

5. Your Blood Sugar Matters on Delivery Day

If you’re scheduled for a C-section or if your obstetrician wants to induce labor, you’ll know your delivery date ahead of time. If not, your baby will decide. Either way, discuss labor and delivery with your obstetrics team in advance so you’re all on the same page.

Reasons To Induce Labor

Some health care providers induce labor in people with diabetes before 40 weeks of pregnancy.

“Most of my patients get induced by 39 weeks,” Dr. Vora said. “When you’re worried about the quality of the placenta, you don’t want to go too far beyond 40 weeks.”

Your obstetrician might also induce labor if they are concerned about the size of the baby and want to avoid a higher-risk delivery.

Intravenous Insulin Drip

To protect the baby’s health, Dr. Vora said most people with diabetes will have an intravenous (IV) insulin drip during delivery.

“The standard of care is to put people on an IV insulin drip,” Dr. Vora said. “Your team can monitor your blood sugars every hour and adjust the drip based on what the blood sugar is doing.” She said insulin pumps and injections are not ideal for this scenario because the insulin is absorbed into the subcutaneous fat first, which can delay its effects. “IV insulin goes straight to the veins, so it kicks in very quickly,” she added.

Dr. Vora explained that insulin resistance decreases dramatically once you give birth, so your health care team will likely stop the insulin drip soon after. Talk to your doctor about how to manage your diabetes after delivery in the hospital. Make sure to schedule a follow-up appointment with your endocrinologist after you give birth.

6. There’s Less Urgency Postpartum

“One benefit of the postpartum period [after pregnancy] is that there’s not as much urgency because we’re not worried about harm to the baby,” Dr. Vora said. “A week or two of mildly uncontrolled blood sugars in a woman postpartum is not going to cause any major long-term harm to health.”

Blood Sugar Management Postpartum

You may face new challenges when managing your blood sugar levels after giving birth.

“Your body goes through so many changes, like weight changes and hormone changes,” Dr. Vora said. “All those things can affect your blood sugars.” Breastfeeding can affect it, too.

​​“We have a little bit more time to figure out what people need after delivery, so we can be a little bit less aggressive in terms of where we need the sugars to be,” Dr. Vora said. “But all those body changes that happen after delivery, in addition to breastfeeding, can require frequent adjustments.”

Caring for Yourself and Baby

Dr. Vora acknowledges that sleep deprivation and grabbing carbohydrate snacks in the middle of the night might be your new normal in the days and weeks after giving birth, and that’s OK. Do your best to enjoy this time and care for yourself while you care for your baby.

“I generally tell my patients to do their best,” Dr. Vora said. “The newborn period can be really tough. You just manage as best you can.”

Talk With Others Who Understand

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Have you given birth while living with type 2 diabetes? Are you thinking about conceiving? Share your experience in the comments below or on your Activities page.