Insulin is often the best option during pregnancy because it does not cross the placenta and is safe for the baby. Some oral medications, like metformin, may be safe, but others may need replacing.
Managing diabetes medication during pregnancy requires careful planning and coordination with healthcare professionals to ensure both parental and fetal health.
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Proper diabetes management during pregnancy is critical to ensuring the health of both the pregnant person and baby, as it can:
- Prevent complications for the baby: Unmanaged blood sugar in pregnancy can cause a large birth weight, a higher risk of neonatal hypoglycemia (low blood sugar after birth), respiratory distress, and jaundice. Longer-term risks
includeTrusted Source a greater likelihood of obesity and type 2 diabetes later in life. - Prevent parental complications: Inadequate blood sugar regulation increases the risk of preeclampsia, cesarean delivery, and infections in the pregnant person. There is also a higher risk of worsening preexisting conditions like diabetic retinopathy or kidney disease.
- Improve pregnancy outcomes: Proper management reduces the risk of miscarriage, preterm birth, and stillbirth.
Diabetes resources
Visit our dedicated hub for more research-backed information and in-depth resources on diabetes.
Gestational diabetes vs. preexisting diabetes
Gestational diabetes (GDM) is a type of diabetes that develops during pregnancy, typically
Preexisting diabetes requires more intensive monitoring and preconception planning, while GDM focuses on managing new-onset glucose intolerance.
| Type | Effects on pregnancy | Management |
|---|---|---|
| Gestational diabetes | • • increased risk of high blood pressure and preeclampsia in the pregnant person • raises the risk of developing type 2 diabetes later in life for both the pregnant person and baby | • lifestyle changes, including managing diet and exercise • insulin or oral medications if blood sugar levels remain unmanaged |
| Preexisting diabetes (Type 1 or 2) | • • higher risk of congenital abnormalities, especially if blood sugar is not managed early in pregnancy • possible long-term risks for both the pregnant person and baby • type 2 often links to obesity, which can worsen complications like preeclampsia | • proper and regular blood sugar management before conception and during and after pregnancy • insulin treatment • ongoing monitoring for diabetes-related complications such as kidney disease and retinopathy |
Pregnancy and parenthood resources
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Insulin is often the preferred treatment during pregnancy because it does not cross the placenta and is safe for the baby.
However, a person may need:
- increased doses as pregnancy progresses, particularly during the second and third trimesters
- adjustments for morning sickness or changes in eating habits
Some oral diabetes medications, like metformin, may be safe. Healthcare professionals may use metformin to manage gestational diabetes, as it offers benefits such as reduced maternal weight gain and fewer complications.
However, it does cross the placenta, and experts are still studying its long-term effects on fetuses.
Glyburide (glibenclamide), another oral medication, is less commonly recommended due to a higher risk of neonatal hypoglycemia and other fetal complications compared to insulin or metformin.
Medical professionals should review all medications for safety during pregnancy. For example, a person should discontinue using ACE inhibitors, and most sources discourage using statins.
If a person with diabetes is thinking of becoming pregnant, it is best to consult a healthcare professional and formulate a preconception plan.
Preconception planning for diabetes is important for ensuring a healthy pregnancy for people with type 1 or type 2 diabetes.
It involves optimizing health and glucose regulation before conception to reduce risks for both the pregnant person and the baby.
Preconception planning often involves a multidisciplinary healthcare team, including an endocrinologist, obstetrician, dietitian, and diabetes specialist.
In addition to changing medication, medical professionals monitor a person’s blood sugar to ensure it is at a healthy level. The target is HbA1c <6%, or as close as safely possible, before pregnancy to minimize risks of complications.
They will also need to address and stabilize any diabetes complications, such as retinopathy, nephropathy, neuropathy, and cardiovascular conditions.
If a person with diabetes is considering pregnancy, it is best to use reliable contraception until the healthcare team has managed blood glucose levels.
Questions to ask a healthcare teamHere are some questions to ask a healthcare team during preconception planning for diabetes:
- Are my current diabetes medications safe for pregnancy? If not, what alternatives should I consider?
- Should I change my insulin regimen before trying to conceive?
- How might my insulin needs change during pregnancy?
- How often should I check my blood glucose levels?
- How can I safely lower my HbA1c if it is currently too high?
- Are there specific foods or nutrients I should focus on before and during pregnancy?
- How long should I wait after achieving target blood sugar levels before trying to conceive?
- What are the specific risks of pregnancy with diabetes for me and my baby, and how can I minimize these risks?
- How might diabetes affect my delivery options, for example, vaginal birth vs. cesarean?
Monitoring diabetes during pregnancy is vital to ensure the health of both the pregnant person and baby.
A person should check blood glucose levels multiple times daily during pregnancy:
- Pre-meal: Before eating, the target blood sugar levels are
<90 mg/dLTrusted Source . - Post-meal: The 1-hour post-meal target level is <140 mg/dL, and the 2-hour post-meal target is <120 mg/dL.
- Bedtime: Before sleeping, which is
<90 mg/dLTrusted Source .
Some people may benefit from a continuous glucose monitoring (CGM) device during pregnancy. This can allow for continuous tracking and fewer fingersticks. It also provides trends and alerts for high or low blood sugar levels.
Other regular tests that will help monitor diabetes during pregnancy
- HbA1c testing: It is best to test every 4 to 6 weeks during pregnancy. The goal is to keep HbA1c as close to <6% as possible.
- Ketone monitoring: A person should test their urine for ketones if their blood sugar is consistently high (>200 mg/dL) or if they are feeling ill or vomiting. Testing prevents diabetic ketoacidosis (DKA), which is dangerous for both parent and baby.
- Weight and blood pressure: A person can regularly monitor weight gain to ensure it is within recommended limits and check blood pressure frequently to catch early signs of preeclampsia (target <130/80 mmHg).
- Fetal monitoring: Ultrasound scans can monitor fetal growth and amniotic fluid levels. Non-stress tests (NSTs) also assess the baby’s heart rate and movement in later pregnancy.
A person may wish to record blood sugar readings, insulin doses, meals, exercise, and symptoms to share with a healthcare professional.
Diabetes medications during pregnancy are chosen carefully to ensure the safety of both the pregnant person and baby.
Insulin is the gold standard for managing both gestational and preexisting diabetes, as it does not cross the placenta, making it safe for the baby.
Medications such as metformin and glibenclamide may be options, but they cross the placenta and may affect the developing fetus.
A person should replace ACE inhibitors and statins with other medications. It is advisable to consult a healthcare professional about medication changes before pregnancy.
