What to Know About Diabetes and Pregnancy

Type 1 and type 2 diabetes are associated with infertility and several pregnancy risks and complications. These include high blood pressure during pregnancy (preeclampsia) and preterm labor or birth.

Diabetes can also develop during pregnancy. This type of diabetes is called gestational diabetes.

If you have diabetes, there are several steps you can take to ensure a safe and healthy pregnancy.

This article looks at different types of diabetes and how they affect fertility and pregnancy. It also discusses some things you will need to do after you have your baby if you have diabetes.

Diabetes and Fertility

Overall, around 10.5% of the U.S. population has diabetes. Complications associated with type 1 and type 2 diabetes, such as being overweight and having polycystic ovarian syndrome (PCOS), can play a role in your ability to get pregnant.

One study found that problems affecting ovulation were the leading cause of infertility in females. Ovulation is the release of an egg into the fallopian tube. PCOS, which is linked to type 2 diabetes, can cause this because it affects the growth and release of the egg.

Type 1 and type 2 diabetes are also associated with irregular or missed periods. This can happen when your ovaries do not regularly release an egg. Missed periods can have an impact on your ability to get pregnant.

Diabetes can also affect male fertility. This is because it can cause nerve damage, which can lead to difficulty maintaining an erection. This can make it more difficult for intercourse and conception to happen. It can also cause a lack of ejaculation, as well as sperm abnormalities like low motility or reduced ability to move.

If you have diabetes, it's very important to keep your blood glucose under control before becoming pregnant. This can help reduce fertility issues and increase your chances of conceiving and having a healthy baby.

See your healthcare provider if you and your partner plan to become pregnant. Your treatment may need to be adjusted before you start trying.

Pregestational Diabetes

Pregestational diabetes refers to people who have type 1 or type 2 diabetes and then become pregnant. It is possible to have a healthy pregnancy if you have preexisting diabetes, but it is important to make sure your blood sugar is well-controlled before you get pregnant.

You will need to keep monitoring your glucose throughout your pregnancy and during labor and delivery. In addition to regular self-testing, continuous glucose monitoring can help you achieve your target glucose levels.

Gestational Diabetes

Gestational diabetes occurs in nearly 10% of pregnancies in the United States. It usually has no symptoms. This is why glucose screening is standard in all pregnancies.

Healthcare providers typically perform glucose screening between the 20th and 24th weeks of pregnancy. It usually consists of a glucose challenge and a glucose tolerance test.

You're given a sweet drink containing 50 grams of sugar during the glucose challenge. After a wait of one hour, your blood will be drawn and tested. If your blood sugar is high, you will need to undergo glucose tolerance testing.

You will need to fast before the glucose tolerance test. For this test, you'll be asked to drink a liquid that contains 100 grams of sugar. Your blood is then drawn and tested at one, two, and three hours. You're diagnosed with gestational diabetes if your blood sugar is high in two or more of these tests.  

If you are diagnosed with gestational diabetes, your doctor will closely monitor you and your baby. You will likely need to change your diet, including limiting carbohydrates. Some people with gestational diabetes need to take insulin to help control their blood sugar. 

If you have gestational diabetes, your blood sugar levels generally return to normal after your baby. However, as many as 50% of people with gestational diabetes develop type 2 diabetes later.

Risks

Diabetes that isn't well managed can cause problems for your baby. This is true whether you had diabetes before you became pregnant or it developed during pregnancy.

Uncontrolled diabetes is linked to a number of risks for you and your baby, including:

• Preterm labor
• High blood pressure (preeclampsia)
• Low blood sugar (hypoglycemia)
• Increased chance of a Caesarean section
• Injury from delivering a large baby
• Birth defects
• Miscarriage or stillbirth
  

If you have any type of diabetes during pregnancy, your healthcare provider may recommend an early planned delivery. This may mean delivering your baby sometime between the 34th and 37th week of pregnancy.

Still, studies have shown that for many pregnancies, the risks of waiting until the 37th to 39th week are low. You and your healthcare provider will decide if early delivery is right for your particular situation.

Treatment

Diabetes treatment is important before, during, and after pregnancy. Managing your diabetes will help reduce the chance of complications. See your healthcare provider early and often to catch any potential problems.

Whether you have type 1, type 2, or gestational diabetes, it is essential to monitor your blood sugar levels often and keep them under control. During pregnancy, your blood sugar goals should be:

• 95 mg/dl or less before meals
• 140 mg/dl or less one hour after meals
• 120 mg/dl or less two hours after meals

Whether you have gestational diabetes, type 1, or type 2 diabetes, this is true.

There are many lifestyle changes you can make to help manage your blood sugar:

• Eating a healthy diet: Pay special attention to your carbohydrate intake. Whole grains, healthy fats, lean proteins, and foods low in sugar are good choices.
• Getting regular exercise: Regular workouts can help fight insulin resistance. Check with your doctor first to make sure exercise is safe for you. Then try to get at least 30 minutes of moderate-intensity physical activity at least five days a week. This could include brisk walking, swimming, or actively playing with children.
  
• Monitoring your blood sugar regularly: Because pregnancy increases the body’s energy needs, blood sugar levels can change very quickly. Check your blood sugar often. It is essential to learn how to adjust food intake, exercise, and insulin depending on your blood sugar tests.

Taking Diabetes Medication During Pregnancy

If medication is required during pregnancy, insulin is usually the first choice. This is because it does not cross the placenta, which means it doesn't affect your baby. Taking insulin as directed by your healthcare provider can help keep your blood sugar levels in a healthy range.

The diabetes drugs Glucophage (metformin) and Diabeta (glyburide) are sometimes also used during pregnancy. These drugs, however, do cross the placenta. It is also important to remember that the long-term safety of these and other oral diabetes medications during pregnancy hasn't been proven.

Concerning Symptoms

If you have any of these symptoms, you may have type 1, type 2, or gestational diabetes:

• Frequent urination, often at night
• Excessive thirst
• Weight loss without trying
• Excessive hunger
• Blurry vision
• Numb or tingling hands or feet
• Fatigue
• Very dry skin
• Sores that heal slowly
• More infections than usual

Talk to your doctor as soon as possible if you experience any of these symptoms.

Diabetes Postpartum

After delivery, you and your baby will both need to have your blood sugar checked.

Low Blood Sugar in Newborns

A baby born to someone who had diabetes before pregnancy has a 50% chance of having low blood sugar at birth. A baby born to someone with gestational diabetes has a 5 to 20% chance of developing this condition.

Because low blood sugar at birth usually does not cause symptoms, your baby will likely receive regular blood glucose tests in the hours after birth. Blood for these tests is taken with a heel stick. Once your baby has normal glucose for 12 to 24 hours, the tests can be discontinued.

Babies with low blood sugar require extra feedings to ensure they're getting enough glucose. In some cases, babies may need IV fluids containing glucose.

Impact on Recovery

You may experience a drop in blood sugar just after your baby is born. This is why it is important to make sure your blood sugar is controlled during labor, delivery, and while you are recovering from the birth.

If you have type 1 or type 2 diabetes, you may be given continuous insulin while you are in labor. Your glucose levels will also be monitored continuously until your baby is born. If you have gestational diabetes, your glucose will be monitored but you may not require intravenous insulin.

If you had gestational diabetes, lifestyle changes can help reduce the risk that you will develop type 2 diabetes after you've had your baby.

The American Diabetes Association recommends that those with gestational diabetes:

• Get tested for prediabetes and type 2 diabetes at four to 12 weeks postpartum
• Undergo lifelong screening at least every 3 years

Breastfeeding

Breastfeeding can have a positive impact on diabetes postpartum. Studies have shown that people who breastfeed have increased insulin sensitivity and improved glucose metabolism.

One study found that breastfeeding for longer than two months lowered the risk of type 2 diabetes by almost half. Still, this is not enough to conclude whether breastfeeding truly lowers the risk of type 2 diabetes after gestational diabetes.

Most diabetes medications, such as insulin and Glucophage, are safe to use while breastfeeding. Check with your doctor about medication doses, however. Your dose may need to be changed while you are breastfeeding.

Summary

Diabetes, whether type 1 or 2, can potentially affect your ability to get pregnant. It may cause problems with ovulation or sperm quality.

Diabetes is also associated with complications like preeclampsia and preterm birth. Work closely with your healthcare team to keep your blood sugar levels under control. This can reduce the risk of complications during pregnancy.

Breastfeeding may help improve insulin sensitivity and glucose metabolism.

A Word From Verywell

Whether you have preexisting diabetes or develop gestational diabetes during pregnancy, know that you are not alone. Diabetes during pregnancy is incredibly common.

Reach out for support from your healthcare team, partner, family, and friends. This can help reduce any stress you may have due to your condition.

Early detection and regular monitoring can ensure a healthy pregnancy, delivery, and postpartum life. You have more control over your condition than you may think.

If you do have concerns, be open and honest with your healthcare provider. Don’t be afraid to ask questions or raise concerns.