Navigating Pregnancy With Type 1 or Type 2 Diabetes

May 25, 2022


Alto Pharmacy

Living with type 1 or type 2 diabetes does not prevent a healthy pregnancy. Thanks to insulin therapy and effective blood sugar management options, many women with diabetes successfully navigate pregnancy, childbirth, and postpartum. While there are some pregnancy risks and challenges tied to type 1 diabetes specifically, careful planning and proactive diabetes management throughout pregnancy can keep you and your baby healthy.

Here’s an overview of what pregnancy with type 1 or type 2 diabetes may look like — from fertility to childbirth and beyond — to help you explore your family building options.

Diabetes and fertility

Many people with diabetes wonder how the condition will impact their fertility. Having diabetes does not mean you will have more difficulty conceiving. Consistently high blood sugar levels are the main way that diabetes can make it challenging to get pregnant. 

Some research has found that women with type 1 diabetes are more likely to have irregular menstrual cycles or delayed ovulation — factors that affect your fertility — but these health issues are also linked to elevated blood sugar. 

High blood sugar can be managed, and informing your doctor of your plans to build or expand your family early on can help you maintain healthy blood sugar levels before you start trying to conceive.

Preparing for pregnancy

While every pregnancy carries the possibility of complications, type 1 diabetes is linked to the following.

  • Preeclampsia — Preeclampsia is a pregnancy complication characterized by high blood pressure that can result in liver or kidney damage. Women with type 1 diabetes may face a greater risk for this complication since they often have higher baseline blood pressure before pregnancy.

  • Insulin resistance — Hormonal changes during pregnancy can make your body less effective at using insulin, resulting in decreased glucose produced from the liver. (This can lead to the development of gestational diabetes in women without preexisting diabetes during pregnancy.) As the placenta grows, insulin resistance increases. This can affect your blood sugar levels.

  • Miscarriage — Women with type 1 diabetes have a higher risk for miscarriage — the loss of a baby before 20 weeks — or stillbirth — the loss of a baby after 20 weeks. Birth defects caused by high blood sugar may be a contributing factor.

  • Macrosomia — Macrosomia refers to a newborn with a higher-than-average birth weight, which can make childbirth more difficult for a mother.

  • Birth defects affecting your baby’s heart, brain, spine, kidneys, digestive system, limbs, and mouth

  • In addition, without effective diabetes management, pregnancy can intensify preexisting diabetes-related complications.

These risks are manageable, however, it’s important to prepare for pregnancy in advance of trying to conceive and to stay vigilant about diabetes management throughout this journey. Preconception planning allows you to work toward health goals and ensure that you have an appropriate care team and medication protocol in place.

When planning a pregnancy, consult your healthcare provider before trying to conceive to review your blood sugar levels, make any necessary adjustments to your treatment plan, and evaluate potential diabetes-related health complications. If you become pregnant unexpectedly, contact your provider as soon as you learn of your pregnancy to discuss blood sugar monitoring, medication changes, and other factors that can lower your risk of pregnancy complications.

Here are some action items to focus on in the months leading up to conception. This is intended to be a high-level guide. Consult your care team for a more individualized plan.

Work toward your A1C goals

Your A1C levels are your average blood sugar levels over a period of two to three months. Your blood sugar levels can impact the development of your baby’s organs during the first 8-12 weeks of your pregnancy, so it’s even more important to maintain healthy blood sugar levels before pregnancy. As you plan for pregnancy, ask your doctor to clarify your A1C goals and how long to maintain them before you try to conceive.

Review your treatment plan and make necessary medication adjustments

Not all medications and supplements are safe to take during pregnancy. Speak with your care team about each medication and supplement you take before trying to conceive. Never stop taking a prescribed medication without first consulting your doctor.

Assemble your diabetes care team

Since there are considerations specific to type 1 diabetes during pregnancy, you may want to look for a healthcare professional who works at the intersection of diabetes treatment and maternal health.

Consider working with an endocrinologist — a physician who treats hormone-related conditions such as diabetes — who focuses on treating pregnant women with diabetes. Alternatively, some OB/GYNs have specialized training in managing diabetes during pregnancy.

You may also benefit from working with a diabetes educator, a healthcare professional certified to coach individuals living with diabetes. They can offer individualized guidance about navigating pregnancy with the condition.

Staying healthy during pregnancy

Vigilant monitoring of your insulin needs and blood sugar levels is the most important thing you can do to have a healthy and safe pregnancy. As your pregnancy progresses, pay attention to changes in how much insulin you need. Many women with diabetes experience lower blood sugar during pregnancy. Continue to revisit your treatment plan with your care team and confirm the recommended dosage and frequency of insulin. 

Blood sugar management tools

There are diabetes supplies that can make it easier to check your blood sugar more frequently. Many pregnant women with diabetes use a continuous glucose monitor (CGM), an electronic device that collects glucose readings every five minutes throughout the day. Talk to your doctor to learn if a CGM is an appropriate option for you.

Insulin delivery methods

Most individuals with diabetes require more insulin throughout pregnancy since insulin resistance typically increases as your pregnancy progresses. You may find it helpful to use an insulin delivery method that eliminates the need for multiple daily injections such as an insulin pump. Additionally, an insulin pen allows for faster administration of insulin injections throughout the day.

Creating a birth plan

Having a birth plan in place can help you prepare for any scenario during labor and delivery. Here is some diabetes-related information to include.

  • Who will monitor your blood sugar levels during and after labor and delivery?

  • What diabetes supplies do you need to pack in your bag, if delivering at a hospital or medical facility?

  • What is the procedure for women who use an insulin pump at your chosen hospital or medical facility? (if applicable)

  • What is the procedure for women who use a CGM at your chosen hospital or medical facility? (if applicable)

Labor, delivery, and postpartum

Blood sugar levels can fluctuate during labor and delivery. They often rise during labor but drop just before or immediately after delivery. Your care team can help you prepare for these possibilities. If using an insulin pump or CGM, speak with your doctor about protocol for continuing to wear these devices during delivery.


Many women assume that they will struggle with breastfeeding due to their diabetes. However, you can breastfeed while living with type 1 or type 2 diabetes. The condition may delay breast milk production but this should improve with time.

Keep in mind that breastfeeding takes up energy, which can affect your blood sugar levels and insulin needs. Some research has found that lactation can increase the risk of overnight hypoglycemia, or severely low blood sugar. Make sure that someone around you understands the signs of hypoglycemia and how to address it.

Resources and support

Above all, remember that you aren’t alone in navigating the challenges of type 1 or type 2 diabetes during pregnancy. In addition to your care team and loved ones, the following organizations can help you connect with other women who understand this experience.

  • Beyond Type 1 and Beyond Type 2 are global online communities for individuals living with diabetes.

  • JDRF is a destination for type 1 diabetes support and community, with opportunities to connect locally with those affected by type 1 diabetes.

View our round-up of diabetes resources

A diabetes pharmacy partner you can rely on

At Alto, we make it as easy as possible to manage diabetes throughout your family building journey. We offer free, same-day delivery of medications and supplies right to your doorstep, and our dedicated diabetes team is here to answer any questions you may have.

Reach out any time via phone at 1-800-874-5881, or in-app messaging.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.