Can a woman with type 2 diabetes get pregnant? Yes, most women with type 2 diabetes can conceive and have healthy pregnancies with careful planning and good glycaemic control. Type 2 diabetes does not prevent conception, but it does require preconception preparation and specialist support to optimise outcomes for both mother and baby. The key is achieving optimal blood sugar control before conception, reviewing medications (as some diabetes drugs are unsuitable during pregnancy), and working closely with a multidisciplinary NHS team throughout pregnancy. With appropriate medical care, women with type 2 diabetes can experience successful pregnancies and deliver healthy babies.

Can Women with Type 2 Diabetes Get Pregnant?

Yes, most women with type 2 diabetes can conceive and have healthy pregnancies with careful planning and good glycaemic control. Type 2 diabetes does not prevent conception or make pregnancy impossible. However, it does require careful planning and management to optimise outcomes for both mother and baby.

Type 2 diabetes affects how the body processes glucose, with insulin resistance being the primary mechanism. During pregnancy, hormonal changes naturally increase insulin resistance, which can make blood sugar control more challenging. Despite this, with appropriate medical support and good glycaemic control, women with type 2 diabetes can experience successful pregnancies.

The key to a healthy pregnancy with type 2 diabetes is preparation. Ideally, women should work with their healthcare team before conception to achieve optimal blood sugar control and review their medications. Some diabetes medications commonly used for type 2 diabetes are not suitable during pregnancy and will need to be changed to insulin or alternative safe options before conception.

If pregnancy occurs unexpectedly, contact your GP, diabetes team or maternity unit urgently for medication review and optimisation. Women are advised to defer conception if HbA1c is 86 mmol/mol (10%) or above, and to work with their diabetes team to improve control first.

It is important to understand that whilst pregnancy is achievable, type 2 diabetes does increase certain risks during pregnancy. These risks can be significantly reduced through preconception planning, regular monitoring and adherence to medical advice. The NHS provides comprehensive support services specifically designed for women with diabetes who are planning pregnancy or are already pregnant, ensuring access to specialist diabetes teams, dietitians and obstetricians experienced in managing high-risk pregnancies.

If you experience any suspected side effects from your diabetes medications, report them via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk or through the Yellow Card app.

Preparing for Pregnancy with Type 2 Diabetes

Preconception planning is crucial for women with type 2 diabetes and should ideally begin at least three to six months before attempting to conceive. The primary goal during this period is to achieve optimal blood sugar control, as good glycaemic control before conception significantly reduces the risk of complications.

Women should request a preconception appointment with their GP or diabetes specialist team. During this consultation, healthcare professionals will:

• Review current diabetes medications and switch any that are unsuitable for pregnancy

• Assess HbA1c levels (the target is typically below 48 mmol/mol or 6.5% before conception, if achievable without problematic hypoglycaemia)

• Advise deferring conception if HbA1c is 86 mmol/mol (10%) or above

• Screen for diabetes-related complications such as retinopathy, nephropathy and cardiovascular disease

• Arrange retinal screening before conception

• Provide advice on diet, exercise and weight management

• Prescribe high-dose folic acid (5 mg daily, available on prescription) from at least three months before conception until 12 weeks of pregnancy to reduce the risk of neural tube defects

Medication review is particularly important. Metformin is usually continued in pregnancy if tolerated. However, most other diabetes medications must be stopped before conception, including:

• SGLT2 inhibitors (such as empagliflozin, dapagliflozin)

• GLP-1 receptor agonists (such as semaglutide, dulaglutide) — these require a washout period before conception; for example, semaglutide should be stopped at least two months before attempting to conceive

• DPP-4 inhibitors (such as sitagliptin)

• Pioglitazone

• Most sulfonylureas

Insulin therapy is the preferred treatment during pregnancy if additional glucose-lowering therapy is needed beyond metformin. Insulin does not cross the placenta and provides precise glucose control. Some women may need to start insulin before conception if their current regimen is inadequate.

Statins must be stopped before conception, as they are contraindicated in pregnancy. Blood pressure medications also require review: ACE inhibitors and angiotensin receptor blockers (ARBs) are contraindicated in pregnancy and should be switched to safer alternatives such as labetalol, nifedipine or methyldopa.

Additionally, women should be screened for other conditions that commonly coexist with type 2 diabetes, such as hypertension and thyroid disorders. Achieving a healthy body weight before conception, where possible, can improve fertility and reduce pregnancy complications.

Managing Blood Sugar Levels Before and During Pregnancy

Tight glycaemic control is essential throughout pregnancy to minimise risks to both mother and baby. NICE guidelines recommend specific blood glucose targets for pregnant women with diabetes: fasting plasma glucose below 5.3 mmol/L and one-hour postprandial glucose below 7.8 mmol/L (or two-hour postprandial below 6.4 mmol/L).

Women will typically need to monitor their blood glucose levels more frequently during pregnancy—often four to eight times daily, including fasting and post-meal readings. Continuous glucose monitoring (CGM) or flash glucose monitoring may be offered depending on local pathways. NICE routinely recommends real-time CGM for women with type 1 diabetes in pregnancy; for women with type 2 diabetes on insulin, CGM or flash monitoring may be considered based on individual circumstances and local commissioning. These technologies can alert users to high or low blood sugar levels and reduce the burden of frequent fingerprick testing.

Insulin requirements typically increase as pregnancy progresses, particularly during the second and third trimesters when placental hormones cause greater insulin resistance. Women using insulin will need regular dose adjustments, often weekly, under the guidance of their diabetes team. This is entirely normal and does not indicate worsening diabetes.

Diet plays a fundamental role in blood sugar management. Women should work with a specialist dietitian to develop a meal plan that:

• Distributes carbohydrate intake evenly throughout the day

• Includes low glycaemic index foods

• Provides adequate nutrition for foetal development

• Helps maintain appropriate gestational weight gain

Hypoglycaemia awareness is important for women using insulin. Pregnant women should carry fast-acting glucose and ensure family members know how to administer glucagon in emergencies. Women on insulin should also be advised about ketone monitoring and sick-day rules: if unwell, test blood or urine ketones and seek urgent medical advice if ketones are positive or if vomiting persists.

Regular contact with the diabetes team—typically every one to two weeks—ensures timely adjustments and addresses any concerns promptly.

Risks and Complications of Type 2 Diabetes in Pregnancy

Women with type 2 diabetes face increased risks during pregnancy, but these can be substantially reduced with good glycaemic control and appropriate monitoring. Understanding these potential complications helps women make informed decisions and recognise warning signs that require medical attention.

Maternal risks include:

• Pre-eclampsia: Women with diabetes have an increased risk of developing this serious condition characterised by high blood pressure and protein in the urine. Low-dose aspirin (75–150 mg daily) is typically prescribed from 12 weeks of pregnancy until birth to reduce this risk.

• Polyhydramnios: Excess amniotic fluid, which can cause premature labour

• Increased caesarean section rates: Due to larger babies or other complications

• Worsening of existing diabetic complications: Such as retinopathy or kidney disease

Foetal and neonatal risks include:

• Congenital malformations: Particularly cardiac and neural tube defects, with risk directly related to blood sugar control around conception

• Macrosomia: Babies larger than 4 kg, which can complicate delivery and increase the risk of birth injuries

• Neonatal hypoglycaemia: Low blood sugar in the baby after birth, requiring monitoring and sometimes treatment

• Respiratory distress syndrome: Even in term babies

• Stillbirth: The risk increases with poor glycaemic control, particularly in the third trimester

It is crucial to emphasise that good blood sugar control significantly reduces these risks. Women who achieve target HbA1c levels before conception and maintain tight glucose control throughout pregnancy have outcomes approaching those of women without diabetes. Regular antenatal surveillance, including growth scans and foetal monitoring, helps identify potential problems early.

Women should contact their diabetes team or maternity unit immediately if they experience:

• Reduced foetal movements

• Severe headaches or visual disturbances

• Persistent vomiting

• Vaginal bleeding

• Severe abdominal or epigastric pain

• Persistent hyperglycaemia with positive ketones

• Signs of preterm labour

NHS Support and Preconception Care for Diabetic Women

The NHS provides comprehensive, multidisciplinary care for women with type 2 diabetes planning pregnancy or who are already pregnant. This specialist support is essential for optimising outcomes and is available free of charge through the NHS.

Women should initially contact their GP or diabetes nurse to express their intention to conceive. They will then be referred to a joint diabetes and antenatal clinic where they will receive coordinated care from:

• Consultant obstetricians with expertise in high-risk pregnancy

• Diabetes specialist nurses and consultants

• Specialist midwives

• Dietitians with expertise in diabetes and pregnancy

• Ophthalmologists (for retinal screening)

Preconception care services include:

• Detailed assessment of diabetes control and complications

• Medication optimisation and contraception advice until ready to conceive

• Education about blood glucose monitoring and insulin adjustment

• Prescription of high-dose folic acid and other necessary supplements

• Lifestyle advice regarding diet, exercise and smoking cessation

Once pregnant, women typically attend more frequent antenatal appointments than those without diabetes—often every one to two weeks. Additional monitoring includes:

• Regular HbA1c measurements (though less reliable during pregnancy)

• Retinal screening: at booking; if normal, repeat at 28 weeks; if retinopathy is present, repeat at 16–20 weeks and again at 28 weeks, with postpartum follow-up as per the NHS Diabetic Eye Screening Programme

• Renal function assessment

• Foetal growth scans (typically from 28 weeks)

• Umbilical artery Doppler studies if indicated

NICE guidelines recommend that women with diabetes should plan birth no later than 40 weeks plus 6 days of pregnancy, with timing individualised based on glycaemic control and any complications. Induction of labour or planned caesarean section may be recommended earlier if there are concerns about the baby's wellbeing.

After delivery, insulin requirements typically drop dramatically, and women can usually return to their pre-pregnancy diabetes regimen. Insulin and metformin are generally compatible with breastfeeding; however, statins should be avoided whilst breastfeeding. Antihypertensive medications should also be reviewed for breastfeeding safety.

Postnatal follow-up is important to reassess diabetes management and provide contraception advice. Women with type 2 diabetes should be informed about the recurrence risk of pregnancy complications and the importance of ongoing glycaemic optimisation and healthy lifestyle for future pregnancies and long-term health.

Frequently Asked Questions