How to manage type 2 diabetes when planning pregnancy at 31?

Hi,

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I read your query and understand your concern.

Yes, you can have a normal pregnancy with type 2 diabetes if you follow the preconception plans.

Preconception plans:

I will provide information, advice, and support to empower you to have a positive experience of pregnancy and to reduce the risks of adverse pregnancy outcomes for both mother and baby. I want to explain to you that:

1. If you have good blood glucose control before conception and throughout your pregnancy, this will reduce the risk of miscarriage, congenital malformation, stillbirth, and neonatal death.

2. When you are planning a pregnancy, you and your family must have information about how diabetes affects pregnancy and how pregnancy affects diabetes.

3. You must also know about:

   1. The role of diet, body weight, and exercise.

   2. The risks of hypoglycemia and impaired awareness of hypoglycemia during pregnancy.

   3. How nausea and vomiting in pregnancy can affect blood glucose control.

   4. The increased risk of having a baby who is large for gestational age increases the likelihood of birth trauma, induction of labour, and instrumental and caesarean section deliveries.

   5. There is a need for diabetic retinopathy assessment before and during pregnancy.

   6. The need for diabetic nephropathy assessment before pregnancy.

   7. The importance of maternal blood glucose control during labour and birth, and the need for early feeding of the baby, to reduce the risk of neonatal hypoglycemia.

   8. The possibility that the baby may have health problems in the first 28 days, and may need to be admitted to a neonatal unit.

   9. The risk of the baby developing obesity, diabetes, and/or other health problems in later life.

4. The normal capillary blood glucose level: You must know the normal capillary plasma glucose target ranges:

1. Fasting plasma glucose level of 5 mmol/litre to 7 mmol/litre on waking, and

2. Plasma glucose level of 4 mmol/litre to 7 mmol/litre before meals and at other times of the day.

3. Glycated hemoglobin (HbA1c) target levels: You must aim to keep your HbA1c level below 48 mmol/mol (6.5%) if this is achievable without causing problematic hypoglycemia. Be reassured that any reduction in HbA1c level towards the target is likely to reduce the risk of congenital malformations in the baby.

I strongly advise women with diabetes whose HbA1c level is above 86 mmol/mol (10%) not to get pregnant until their HbA1c level is lower, because of the associated risks.

I suggest you take a tablet of 5 mg of Folic acid at night for the three-month preconception period. Start taking the tablet Metformin 500 mg in the morning and at night, for the preconception period, and continue during pregnancy; it is safe to take it. Also, consider starting insulin if you have not started yet. Consult your specialist doctor, discuss with him or her, and take the medicines with their consent.

Hope this answers your query.

Thank you