Lifestyle

Sweet expectations: 5 key questions about diabetes and pregnancy

Published on 11 February 2025

If you are living with diabetes and planning to get pregnant, here is how to keep both you and your baby healthy.

Getting pregnant while living with diabetes can feel overwhelming. After all, there are several factors to consider, from blood sugar control and medication adjustments, to monitoring potential risks for both mother and baby.

However, with the right planning and support, individuals with diabetes can have a safe pregnancy and welcome a healthy baby.

Here’s everything you need to know about pregnancy and diabetes.

1. Is it harder for women with diabetes to get pregnant?

No – diabetes typically does not reduce fertility. However, unstable blood sugar levels can increase the risk of complications, such as miscarriage or birth defects.

“Many women with diabetes conceive successfully,” revealed Dr Yew Tong Wei, Senior Consultant, Division of Endocrinology, Department of Medicine, National University Hospital (NUH). “However, their blood sugar levels need to be well-managed, as poorly controlled diabetes can raise the risk of abnormalities in the baby, such as a hole in the heart or other abnormal organ formation.”

Some complications include having a larger-than-normal baby, as excess glucose from the mother can cause the baby to grow too large, increasing the likelihood of a caesarean delivery. Other risks include neonatal hypoglycaemia (low blood sugar in newborns caused by lingering high insulin levels due to exposure to maternal glucose) and, in severe cases, stillbirth.

So, if you are considering getting pregnant, it is crucial to get your blood sugar levels under control before you start trying.

2. How should I prepare for pregnancy if I have diabetes?

Ideally, start planning at least six months before trying to conceive. Key steps include:

Talk to your doctor early: This allows time to adjust your medications to ensure they are safe for pregnancy. For example, insulin or metformin is typically recommended over other diabetes medications for pregnant women, and their doses need to be optimised to get your sugar levels to ideal levels.
Check for complications: Undergo baseline screenings for your eyes and kidneys, as diabetes can worsen these conditions during pregnancy.
Manage other health conditions: If you have high blood pressure or cholesterol, your doctor may recommend switching to pregnancy-safe medications or stopping some of them.
Take folic acid: Begin a folic acid supplement to reduce the risk of birth defects.

While you work towards optimal diabetes control, use contraception until you are ready to conceive.

3. What if I am already pregnant and was not planning for it?

If you have just discovered you are pregnant and it was not planned, do not panic — but do act quickly. Early action is crucial, as the baby’s organs develop during the first 12 weeks.

“See a doctor as soon as possible,” said Dr Yew. “You’ll need to quickly switch to pregnancy-safe medications, if necessary, and intensify blood sugar monitoring to minimise risks.”

You might also need to check your blood sugar up to seven times a day — before and after meals, and before bedtime. In addition, you will have to share these readings with your healthcare team regularly, perhaps every two or three days, so they can adjust your medication as needed.

Dr Yew explained that pregnancy hormones can make managing diabetes feel like aiming at a “moving goalpost,” as they cause blood sugar levels to fluctuate significantly. This means medications and lifestyle habits may require frequent adjustments.

“What works for your blood sugar control today might need changing next week because of hormonal shifts,” said Dr Yew. “Staying in close contact with your healthcare team is essential to adapt to these changes.”

4. Are there unique challenges for women with polycystic ovarian syndrome (PCOS) and diabetes?

If you have PCOS alongside diabetes, managing both conditions can be more challenging. PCOS is associated with insulin resistance, which can complicate diabetes management and may also impact fertility. Work closely with both your obstetrician and diabetes care teams to optimise your chances of conceiving and ensuring a healthy pregnancy.

5. What should women who are unaware of their diabetes status do?

Not knowing you have diabetes can be risky, especially during pregnancy, as you may miss the opportunity to manage your blood sugar during the critical first trimester.

The Health Promotion Board recommends that:

Women aged 40 and above should get screened for diabetes.
Younger women should consider screening if they have risk factors such as high blood pressure, obesity or a family history of diabetes.

You can also try this simple online diabetes risk calculator to check if you should get screened. Early detection allows you to manage diabetes effectively before or during pregnancy.