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What to Expect If You’re Expecting: Pregnancy With Diabetes

Pregnancy can be both an exciting and stressful time. Adding diabetes into the mix, whether it's type 2 diabetes or another form, can be challenging. For most people, the workload of managing diabetes increases, and the worry over your baby's health is always present. While you can't change how your body works, it's helpful to know what to expect and what you can do about it.

Hormone changes and blood sugar

Hormone changes can make blood sugar management more difficult as you get farther into your pregnancy. These hormone changes make your body become more insulin resistant. If you have type 2 diabetes, you may be worried about this change since insulin resistance was a part of your body's struggle for healthy blood sugars before pregnancy. 

Medication expectations

As your pregnancy moves into later stages, medication changes may be necessary. If you didn't need medication before pregnancy, you might need it added during pregnancy. Insulin doses may need to be increased over time if you take insulin.

Impact of breastfeeding

Once the baby is delivered, your hormones change again, and your medication needs to decrease. Breastfeeding also impacts blood sugar levels. Depending on the medication you take to manage your diabetes after delivery, you may need to have a small snack when you nurse to prevent low blood sugars.1,2

Changes to blood sugar tracking and goals

Blood sugar tracking and goals are different in pregnancy. Glucose goals are often lower than before pregnancy. Even with hormone changes (which make keeping blood sugars in a healthy range harder), the goal for healthy blood sugar levels is still lower than non-pregnancy ranges. 

Glucose management expectations

Many providers will ask you to check blood sugars first thing in the morning before food (fasting) and 1 hour after each meal. They also may ask you to check before meals. Depending on which guidelines your provider uses, goals for blood sugars in pregnancy might be:1

  • Less 90 mg/dl fasting
  • Less than 130 or 140 mg/dl 1 hour after meals

Be sure to ask your provider how often you should check your goal blood sugar levels and when you should call them about blood sugars concerns.1

Higher risk of preeclampsia

People with diabetes who are pregnant have a higher risk of preeclampsia. Preeclampsia is a high urine protein and blood pressure level during late pregnancy. Preeclampsia causes health risks to both you and your baby. If you experience preeclampsia, it may be possible that your baby needs to be delivered early.1

How to decrease the risk

The American College of Obstetricians and Gynecologists (ACOG) recommends women with diabetes start a low dose of aspirin to decrease their risk for preeclampsia. The aspirin should be started before your 16-week appointment and taken until the end of your pregnancy. As your first trimester ends, ask your provider if starting a low-dose aspirin is right for you.3

Early testing and screening

If you have diabetes complications, pregnancy may make them worse. Be screened early and regularly for any diabetes complications, especially as soon as you know you're pregnant. These screenings include kidney tests and eye exams.

Stay in touch with your healthcare team

Based on your results, you may need more testing or appointments as your pregnancy progresses. Close contact with your obstetrician and other specialists will be important to monitor your health and diabetes complications during the pregnancy.1

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