How can type 2 diabetes affect pregnancy?

High blood sugar levels can produce bigger babies, which can lead to complicated and difficult labours. Larger babies are often delivered by caesarean section, a procedure that carries greater risks to both mother and baby, and has a much longer recovery time than a vaginal birth. High blood sugar levels can also affect the development of a baby's organs, especially in the first 8 weeks of a foetus' development, which can lead to birth defects in the heart, spine, and brain.

Mums-to-be with diabetes are also more likely to suffer from high blood pressure. During pregnancy this can cause pre-eclampsia, a condition that affects the arteries carrying blood to the placenta. High blood pressure and pre-eclampsia can be very dangerous during pregnancy with the potential to cause a premature birth as well as seizures and strokes in the mother during labour. Women who suffer from diabetes tend to have a higher chance of having a miscarriage, stillbirth or premature delivery.[1]

What can I do to look after myself and my baby?

Navigating pregnancy with diabetes might sound daunting, but once you know the risks you can take the appropriate actions to have a safe pregnancy that keeps both you and your baby healthy.‍

1. Control and monitor your blood glucose levels

It might sound obvious but keeping an eye on your blood sugar levels is super important throughout your pregnancy. If you are thinking of trying for a baby it’s strongly advised that your blood sugar levels are at a healthy level at least 6 months before you conceive. The NHS advises a healthy level is 6.5% and under; if your levels are 10% or higher then you should wait until these are lower before trying for a baby.[2]

Morning sickness and changes to your diet (hello cravings!) can affect your blood sugar levels so you’ll need to test your levels far more regularly than you normally would throughout your pregnancy; if you don't already have a blood sugar testing kit you can ask your healthcare professional for one. Your doctor will talk to you about what a healthy blood sugar level looks like for you but as a general rule, sources suggest generally aiming for: [3]

• When you haven't eaten - below 5.3mmol/L

• 1 hour after eating - below 7.8mmol/L, or 2 hours after meals - below 6.4mmol/L
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2. Nourish your body

Diet plays an important part in managing diabetes and even more so during pregnancy. You might have heard that when you’re pregnant you need to eat for two but sadly this is just a myth...instead, make sure you’re not overeating! Your calorie intake shouldn't actually increase until your third trimester and even then you should only consume an extra 200 calories a day - the equivalent of a small snack. Aim to eat small, regular, balanced meals that include carbohydrates, lots of fruits and vegetables, dairy products, pulses, meat, and fish, bearing in mind that carbohydrates have the biggest impact on your blood sugar levels.

Aim to eat small, regular, balanced meals that include carbohydrates, lots of fruits and vegetables, dairy products, pulses, meat, and fish

It’s also worth incorporating supplements into your diet, particularly folic acid and vitamin D. Folic acid helps prevent birth defects such as spina bifida and should be taken before you start trying for a baby, continuing until the 12th week of pregnancy. Pregnant women with diabetes will need to take about 5mg, which is a higher dose than normal and must be prescribed by a doctor.[2] Make sure you're also getting lots of vitamin D to help develop your baby's bones, teeth, heart and nervous system.

3. Keep up the (gentle!) exercise

Pregnancy can be hard work; as your baby grows you'll likely feel tired and worn out, not to mention dealing with all the other aches and pains that come with creating a human! Exercise might be the last thing on your mind but it's important to stay active throughout your pregnancy, especially if you have diabetes. Physical activity not only helps keep you and your baby at a healthy weight but it also helps to lower your blood sugar levels. Exercise is also a great natural mood booster, helping to reduce anxiety and lower stress levels - perfect if you’re feeling overwhelmed and anxious about your pregnancy (which is totally normal!).

Exercise doesn't have to, and shouldn’t be, hard. It can simply be choosing to walk to the shops instead of taking the car or doing an extra lap of the park on your daily walk; you could also try swimming or prenatal yoga, both of which are great for strengthening ligaments and increasing flexibility, and can result in shorter, easier labours. It's important to tell your doctor or midwife about your exercise plans but you should aim to try and complete at least 30 minutes of exercise every day, 5 days a week, avoiding anything that could result in injuries like horse riding or contact sports.
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4. Attend regular checkups

Throughout your pregnancy your doctor and midwife will keep a close eye on you, making sure you and your baby are safe and healthy. It’s important to attend all your appointments as pregnancy can increase the risks of certain diseases in women with diabetes that need to be monitored. One such risk is an eye disease called diabetic retinopathy, where increased blood sugar levels damage the back of the eye. If left undiagnosed or untreated, diabetic retinopathy can cause blindness. Pregnancy can increase the risk of the condition so make sure to attend regular eye screening appointments.

Regular checkups are also a good way for your healthcare team to monitor your weight gain and, if needed, adjust your medication. Certain diabetes medications may be harmful to your baby so it's really important to always follow your doctor's advice. 

You've got this!

Managing diabetes throughout pregnancy might feel overwhelming at times but there’s nothing to say you can’t have an easy, enjoyable pregnancy as long as you’re checking in regularly with your medical team, following their advice and paying close attention to your diet, exercise and blood sugar levels. Try to enjoy this special time in your life and remember, you’ve got this!