Can a 34-year-old woman with diabetes conceive safely?

Question

Hello doctor,

I was diagnosed with type 2 diabetes two years ago, and my blood sugars are still not very well controlled despite medication and diet changes. I am 34 years old, married, and planning for pregnancy, but I am worried about how diabetes might affect my ability to conceive or carry a healthy baby.

Do women with type 2 diabetes have a higher risk of infertility or miscarriage?
Will my baby be at a higher risk of birth defects or developing diabetes later in life?
If I choose IVF (in vitro fertilization), do doctors need to adjust the hormonal medications because of my blood sugar levels?
I also sometimes experience very heavy and painful periods. Could this be related to my diabetes?
Can diabetes make PCOS (polycystic ovarian syndrome) symptoms worse?
What is the best form of birth control for someone like me if I want to delay pregnancy for a year?
Finally, does menopause occur earlier in women with diabetes?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

When women with diabetes are planning a pregnancy, provide them and their families with information about how diabetes affects pregnancy and how pregnancy affects diabetes. The information should cover:

The role of diet, body weight, and exercise.
The risks of hypoglycemia and impaired awareness of hypoglycemia during pregnancy.
How nausea and vomiting in pregnancy can affect blood glucose control.
The increased risk of having a baby who is large for gestational age increases the likelihood of birth trauma, induction of labor, and instrumental and cesarean section deliveries.
The need for diabetic retinopathy assessment before and during pregnancy.
The need for diabetic nephropathy assessment before pregnancy.
The importance of maternal blood glucose control during labor and birth, and the need for early baby feeding to reduce the risk of neonatal hypoglycemia.
The possibility that the baby may have health problems in the first 28 days, and may need to be admitted to a neonatal unit.
The risk of the baby developing obesity, diabetes, or other health problems in later life.

Agree on individualized targets for self-monitoring of blood glucose with women who have diabetes and are planning a pregnancy, taking into account the risk of hypoglycemia.

Advise women with type 1 diabetes who are planning a pregnancy to aim for the normal capillary plasma glucose target ranges:

On waking, a fasting plasma glucose level of 5 mmol/liter to 7 mmol/liter.
A plasma glucose level of 4 mmol/liter to 7 mmol/liter before meals, and at other times of the day.

Target HbA1C level for the preconception period.

Advise women with diabetes who are planning a pregnancy to aim to keep their HbA1c (glycated hemoglobin) level below 48 mmol/mol (6.5 percent), if this is achievable without causing problematic hypoglycemia.
Reassure women that any reduction in HbA1c level towards the target will likely reduce the risk of congenital malformations in the baby.
Strongly advise women with diabetes whose HbA1c level is above 86 mmol/mol (10 percent) not to get pregnant until their HbA1c level is lower, because of the associated risks.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.