Daijiworld Media Network – New Delhi

New Delhi, Dec 9: Thinking of starting a family while living with diabetes? Doctors say it is absolutely possible — provided women plan early, optimise their blood sugar levels and make key lifestyle changes before conception. Experts warn that skipping pre-pregnancy preparation can turn a routine pregnancy into a high-risk one, but with timely medical guidance, most complications can be prevented.

Specialists underline that women with diabetes require more medical supervision and pre-conception planning than others. Good blood sugar control prior to pregnancy sharply reduces risks of miscarriage, congenital anomalies, preeclampsia, and poor fertility outcomes.

“Aim for HbA1c ≤ 6.5% before pregnancy”

Speaking to The Times of India, Dr Usha Ayyagari, Endocrinologist at Apollo Clinic, Chennai, said achieving optimal glucose control is the most crucial step. “Aim for an HbA1c of ≤6.5%, adjusted individually to avoid hypoglycaemia. Maintaining stable blood sugars for at least three months before pregnancy lowers risks of miscarriage, congenital anomalies and preeclampsia,” she said.

Tools such as continuous glucose monitoring (CGM), she added, help women stay within target ranges safely.

Dr Ayyagari cautioned that several diabetes medications — including SGLT2 inhibitors, GLP-1 receptor agonists, statins, ACE inhibitors and ARBs — are unsafe in pregnancy. Women must consult their endocrinologist early to switch to pregnancy-safe alternatives.

She emphasised the need for folic acid supplementation, recommending 5 mg/day at least three months before conception to reduce neural-tube defects.

Healthy weight management also improves fertility. Even a 5–10% weight loss boosts ovulation, reduces insulin resistance and increases the chance of conception. Regular moderate exercise — walking, strength training or yoga — plays a key role. Managing PCOS is equally important, as women with PCOS are at a higher risk of diabetes.

Balanced diet, stress control and lifestyle changes

Adding to this, Dr Mahesh DM, Consultant – Endocrinology, Aster CMI Hospital, Bengaluru, said balanced meals with whole grains, vegetables, lean proteins and healthy fats help avoid glucose spikes. Avoiding refined sugars, large meals and late-night eating stabilises blood sugar levels.

He highlighted the importance of stress management through meditation, quality sleep and deep breathing techniques, which support hormonal balance and enhance the chances of conception.

The experts also recommend thyroid screening, as thyroid disorders — especially hypothyroidism — are more common in women with diabetes and can affect fertility. Screening for retinopathy, neuropathy, nephropathy and hypertension is essential since these conditions can worsen during pregnancy.

Doctors also advise vaccinations, avoiding smoking, and limiting alcohol to reduce miscarriage and congenital risks.

“Unplanned pregnancies are high-risk,” doctors warn

“Unplanned pregnancies in women with diabetes carry a high risk. Use reliable contraception until blood sugars and medications are optimised,” Dr Ayyagari stressed.

With early planning and coordinated care between a diabetologist and a gynaecologist, doctors say women with diabetes can safely conceive and have healthy pregnancies.

What research shows

A 2019 Diabetes Care study found that women with poor pre-conception glycaemic control (HbA1c ≥ 7.0%) had significantly higher rates of congenital malformations (9.3% vs 3.6%) and perinatal deaths.
A 2021 Diabetologia meta-analysis reported that each 1% rise in pre-pregnancy HbA1c increased the risk of preeclampsia by 18% and preterm birth by 15%. Women with HbA1c ≥ 6.5% had higher odds of miscarriage and foetal loss.
A 2022 BMC Pregnancy and Childbirth study found that women who stabilised blood glucose through diet, exercise and pre-pregnancy counselling had a 30% lower risk of first-trimester miscarriage and 25% higher chance of live birth.

Clear roadmap for women with diabetes

– Keep HbA1c around ≤6.5–7.0% before pregnancy
– Optimise diet, exercise, weight and metabolic health
– Begin folic acid supplementation early
– Review medications and screen for thyroid and other complications
– Plan pregnancies only after medical clearance

With the right preparation and monitoring, doctors say diabetes need not be a barrier to motherhood — instead, it can become a journey of awareness, resilience and careful planning.