If you have Type 2 diabetes and are pregnant or hoping to conceive, you’ve likely heard all the scare-tistics: expectant moms with T2D are at higher risk of experiencing a miscarriage or stillbirth and having preeclampsia or a Cesarean section [1]. Their babies are at higher risk of having a birth defect or being born too early. While that might sound grim, the good news is that despite the risks, there are lots of things you can do to have your healthiest pregnancy possible, even with Type 2 diabetes! Making the small changes listed below, both before and during pregnancy, can have a big, positive impact on your health and your baby’s.
Type 2 diabetes tips before pregnancy
1. Make sure your diabetes is well managed
Ideally, be sure your blood sugar is consistently within normal range (talk to your doctor about your goal numbers) before you try to conceive. It may take longer for women with unmanaged Type 2 Diabetes to conceive, because of the effects of increased glucose levels on the reproductive system. When diabetes is left unmanaged, or not as well managed as it could be, the excess glucose and insulin can hinder ovulation, making it more challenging to conceive. Ovulation problems are a hallmark of polycystic ovary syndrome (PCOS), which often goes hand-in-hand with Type 2 Diabetes [2]. Monitoring your glucose levels and partnering with your medical provider may make it easier to conceive when the time is right.
2. Work with your doctor to prevent obesity
Women of all body types and weights can successfully carry a pregnancy, but those who are obese may have a harder time conceiving and a more challenging pregnancy (think the risks mentioned above)[3]. Women with a BMI of less than 30 reduce their risk of these challenges. If you’re diabetic and/or overweight and thinking about trying to get pregnant in the future, start talking with your doctor now about healthy ways to lose weight.
3. Aim for A1C of 6.5 or lower
Your A1C level gives you a great snapshot of how the body is regulating glucose production. It reflects your average blood sugar levels in the last three months. Women with A1C levels of 6.5 and below are less likely to have early pregnancy complications caused by high glucose levels. Glucose can have a significant impact on the formation of fetal organs in the first few weeks of pregnancy, so it’s ideal to have this managed before pregnancy is attempted. Ask your doctor about what medications for diabetes (like Metformin) or diabetes complications (like ACE inhibitors for kidney disease) are safe to take when you’re trying to conceive.
4. Create your perfect healthcare team
They say it takes a village to raise a child, but— especially if you have diabetes— it takes a great team to get there, first! As you prepare for pregnancy, begin researching medical providers who have experience with Type 2 Diabetes. You may want to interview several OB/GYNs, Maternal Fetal Medicine providers (also called “MFMs”, these high-risk doctors are often required for mothers with Type 2 diabetes), and/or Certified Diabetes Educators or Registered Dietitians. While you may feel confident about managing your diabetes now, there may be unexpected changes in pregnancy through which this team can confidently guide you!
Type 2 diabetes tips during pregnancy
5. Eat the most important meal of the day — breakfast!
There’s plenty you can do to have your healthiest pregnancy with Type 2 diabetes, and it all starts with breakfast. A savory breakfast that includes healthy fats and a source of protein can set you up for success the rest of the day by preventing sharp spikes or drops in blood sugar in the early hours. Eating within one hour of waking can also help stabilize your blood sugar from your overnight fast.
When pregnant, some women experience “morning sickness,” consisting of nausea and sensitivity to smells and foods. If you notice this nausea first thing in the morning, it is not recommended to avoid eating. Instead, try out different breakfast options that may sit better with your stomach, such as avocado toast, a ham and cheese omelet, or greek yogurt with almonds and chia seeds.
6. Monitor your glucose levels more closely during pregnancy
Even women with well-managed diabetes will experience changes throughout pregnancy. Work closely with your providers to pinpoint which medications and dosages serve you best. In order to provide your healthcare team with the information they need, continue to monitor your blood sugar at regular intervals and meal times throughout the day. Ask your doctor if a continuous glucose monitor is right for you.
7. Meet with a nutritionist
Consider meeting with a nutritionist to help you plan your meals. They can help make sure that you stay within the weight gain recommended for pregnancy and help you understand how your body responds to different foods.
8. Have fun after a doctor’s visit!
As a woman with Type 2 diabetes, you are likely to have to visit the doctor’s office more frequently than women without diabetes. These appointments are to help monitor your glucose, medication dosages, and also the health of the baby, but some women may (understandably) find them stressful. Incorporating something fun during or after these visits can make them a little bit easier! You could invite a close friend to go along with you and keep you company, bring along a book or magazine you’ve been dying to read, or even schedule a relaxing “treat” like a pedicure or spa day afterward, as you’re able.
9. Experiment with well-balanced meals that incorporate your cravings
Women often experience food cravings throughout pregnancy. Incorporate your cravings into your meals in a healthy way, always making sure they are balanced. Craving bagels? Enjoy half a bagel with cream cheese along with your veggie omelet in the morning. Even if your cravings include starches that may increase blood sugar, if they are incorporated in a smart way along with balancing proteins and fiber, indulging may be just fine. Monitor your blood sugar to check for any significant response and check with your provider.
10. Keep your body moving!
It’s important for all women to keep their body moving during pregnancy. Ideal ways to do this may be swimming, active walking, or riding a stationary bike. If you were already active before pregnancy, maintain the level of exercise you’re used to. If you were lifting weights prior to pregnancy, you should continue to do this throughout your pregnancy. Building lean body mass is a great way to improve insulin sensitivity and balance blood sugar. Another benefit to exercise? It may shorten your labor [4]! If you didn’t previously exercise, add in one or two casual walks a day. Movement is good for you and your baby!
Yes, there are some scary statistics out there about what could happen if you’re pregnant and have Type 2 diabetes. But there is plenty that’s within your control to do so you can have your healthiest pregnancy possible. Your health and your baby’s health are so worth the effort!
Additional Reading:
Can diabetes keep you from getting pregnant?
Natural Womanhood Book Review: Real Food for Fertility
References:
[1] Weissgerber TL, Mudd LM. Preeclampsia and diabetes. Curr Diab Rep. 2015 Mar;15(3):9. doi: 10.1007/s11892-015-0579-4. PMID: 25644816; PMCID: PMC4317712. [2] Livadas S, Anagnostis P, Bosdou JK, Bantouna D, Paparodis R. Polycystic ovary syndrome and type 2 diabetes mellitus: A state-of-the-art review. World J Diabetes. 2022 Jan 15;13(1):5-26. doi: 10.4239/wjd.v13.i1.5. PMID: 35070056; PMCID: PMC8771268. [3] Fontana R, Torre SD. The Deep Correlation between Energy Metabolism and Reproduction: A View on the Effects of Nutrition for Women Fertility. Nutrients. 2016; 8(2):87. https://doi.org/10.3390/nu8020087 [4] Watkins VY, O’Donnell CM, Perez M, Zhao P, England S, Carter EB, Kelly JC, Frolova A, Raghuraman N. The impact of physical activity during pregnancy on labor and delivery. Am J Obstet Gynecol. 2021 Oct;225(4):437.e1-437.e8. doi: 10.1016/j.ajog.2021.05.036. Epub 2021 Jun 1. PMID: 34081895; PMCID: PMC10564562.
