One of the commonly believed myths is that experiencing a healthy and normal pregnancy is harder for women with type 2 diabetes. It isn’t difficult for them to conceive, provided they take care of few parameters such as their HbA1c, weight, daily blood sugar levels, cholesterol and thyroid levels. It becomes important, in such a scenario, to counsel expecting mothers that type 2 diabetes and pregnancy can both be easily managed with the proper guidance.
Uma Mathur, 28, had been consulting Dr. Silviya Irene, Endocrinologist at Sitaram Bhartia Hospital’s Diabetes Center (South Delhi) for 5 years for her type 2 diabetes. She had been trying to conceive with her husband for a few months when she decided she would seek Dr. Silviya’s advice.
“I was unsure if my condition could adversely affect my baby in any way as I had read unfavourable stories online. I realised I needed medical guidance before we got pregnant,” recalled Uma.
Dr. Silviya reassured her that pregnancy is a natural event that she should not stress over. She encouraged Uma to clarify all her doubts during the consultation.
Can a woman with type 2 diabetes get pregnant?
“Is it harder for women with diabetes to get pregnant?” asked a worried Uma.
“The most important thing that matters for women looking to conceive is good glycemic control. You will be advised to keep a close eye on your glucose levels before and throughout gestation,” counselled Dr. Silviya.
The recommended range of HbA1c for women trying to get pregnant should be less than 6.5.
“Such strict control needs to be maintained before you start planning your pregnancy so that the infant is not exposed to unnecessary risks that come with spikes in sugar levels.”
The regularity of your menstrual cycles is also important as unbalanced sugar levels and weight can lead to irregular cycles. It is advised that you discuss these issues with your doctor at least 3 months before you plan your pregnancy in order to achieve smooth outcomes.
How does type 2 diabetes affect pregnancy?
Diabetes is often associated with comorbid conditions like PCOS, hypothyroidism, obesity, cholesterol issues, hypertension, etc. Each of these parameters lead to a vicious cycle of each promoting the other. This is why they need to be given special focus in women with type 2 diabetes trying to conceive.
Another thing to note is that the the concept of pregnancy with type 2 diabetes start from healthy ovulation till delivery. There are a number of intricate hormonal changes going on throughout for which maintaining normal sugar levels around the cells is needed, which makes achieving a good HbA1c is the crux.
Complications associated with type 2 diabetes and pregnancy also include birth deformities in newborns. If the mother is unable to strictly regulate her lifestyle and bring her blood sugars under control, the child can be, for example, born larger than normal.
“Can diabetes affect female fertility?” Uma wanted to confirm.
Dr. Silviya answered – “No, diabetes does not affect female fertility. Poorly controlled blood glucose levels can affect the conception rates of women. They may increase significantly with well-regulated sugar levels.”
Uma felt encouraged after hearing Dr. Silviya’s reassuring words. Looking forward to a healthy pregnancy, she wondered if she would have to undertake any special steps during the gestation period.
Management of Type 2 Diabetes and Pregnancy
The most important step towards regulating blood sugars can be taken by properly planning the pregnancy and managing diabetes. Uma felt more at ease when she was told she did not need to do anything out of the ordinary and was counselled about her diet, exercise, and medication.
1. Diet
“Sustaining a stricter diet and lifestyle regime, as well as maintaining a healthy weight during the gestation period is the key.”
There is a higher requirement for calorie, calcium, protein, folic acid and iron intake in pregnancy. It becomes important to incorporate food items rich in these nutrients and vitamins in your daily pregnancy diet.
Uma was advised to sit with our Diabetes Educator and prepare a customized meal plan for pregnancy with type 2 diabetes.
“Your nutrient requirements depend on varying factors such as height, weight, physical activity, carb intake, HbA1c, etc. As the nutrients you take in during pregnancy are transferred to your baby, it is important you consult your doctor to determine your body’s requirements. This is why dietary advice differs from person to person during consultations with our diabetes educators.”
2. Exercise
As per ADA guidelines, women with pre-existing diabetes who are experiencing a normal, healthy pregnancy are advised to walk for at least 30 minutes per day, 5 days a week.
However, if complications arise during the pregnancy then our team of gynecologists and physiotherapists will work together to customize an exercise regime according to your health and medical history.
3. Medication
“Oral medicines for diabetes treatment are not safe for the baby. When the conception is confirmed, the oral medicines are stopped and insulin is initiated. This is then continued through their gestation period as well.”
Women may also be suggested to switch to insulin even before conception in order to achieve better control over their glucose levels sooner. This is often suggested if expecting mothers are not able to achieve their targets despite dietary or lifestyle changes.
“Will I be able to switch back to my oral medicines after delivery?” asked Uma.
Oral medicines can be secreted from the mother’s milk to the newborn during breastfeeding and expose them unnecessarily to the medicine. Mothers are advised to stick to insulin till the time they are breastfeeding their infant.
“Don’t be apprehensive about taking insulin before or during pregnancy! You don’t need to take it permanently and the dosage will be monitored frequently by your doctor. Make sure you come in for regular follow-ups as the dosage may be subject to change even every week, over the course of your pregnancy.”
After an in-depth sitting with the diabetes team, Uma came out feeling more confident. Keen on having a normal delivery, Uma wondered if her delivery would involve any medical interventions.
Is normal delivery possible in type 2 diabetes?
“The belief that all women with diabetes require a cesarean if they are pregnant is a misconception. Having diabetes does not make you a candidate for a cesarean section Having good sugars without fluctuations during pregnancy can prevent large (oversized) babies and increases the chance of a normal delivery.”
The goals for blood sugar for women with type 2 diabetes are different during pregnancy:
- Fasting – less than 90 mg/dl
- Pre-meal or before eating- less than 95 mg/dl
- 1 hr post meals – less than 140 mg/dl
- 2 hr post meals – less than 120 mg/dl
Uma took Dr. Silviya and her team’s advice into consideration and felt better prepared for her pregnancy journey ahead. After a successful conception, she went on to have a healthy pregnancy and a safe delivery as well!