Yes, you can get pregnant with diabetes. Women with both type 1 and type 2 diabetes have healthy pregnancies and healthy babies every day. The key difference is that diabetes adds real risks to pregnancy, and most of those risks shrink dramatically when blood sugar is well controlled before and during conception. The single most important number to know: the American Diabetes Association recommends an A1C below 6.5% before you start trying to conceive.
How Diabetes Affects Fertility
Diabetes can make it harder to conceive, though it certainly doesn’t make it impossible. Chronically high blood sugar creates oxidative stress that damages the cells surrounding your eggs (called granulosa cells), which are responsible for producing the hormones that drive ovulation. When those cells are injured, hormone production drops. Elevated glucose in the fluid around developing eggs can also accelerate cell death in the ovaries, reducing overall egg reserve over time.
For women with type 2 diabetes, insulin resistance often overlaps with polycystic ovary syndrome (PCOS), which independently disrupts ovulation. The combination can make cycles irregular or absent. Getting blood sugar under control, losing even a modest amount of weight if relevant, and working with a care team can restore more regular ovulation for many women. Some will need fertility support, but many conceive on their own once glucose levels improve.
Why Preconception Planning Matters So Much
The most critical window for your baby’s development is weeks 5 through 8 of pregnancy, when the major organs form. Most women don’t even confirm a pregnancy until partway through that window. That’s why blood sugar control before conception is so important: by the time a pregnancy test turns positive, the highest-risk period for birth defects is already underway.
The numbers are stark. In a large study of women with pregestational diabetes, the overall rate of major birth defects was about 8%, compared to roughly 3% in the general population. When A1C reached 10%, the anomaly rate climbed to 10%. At an A1C of 13%, it reached 20%. But women who brought their A1C below 6.5% before conception had risk levels much closer to the general population. This is why every major guideline emphasizes preconception care as the single most impactful step you can take.
Miscarriage Risk and Blood Sugar
Poorly controlled diabetes also raises the chance of miscarriage. In one retrospective study, women with higher A1C values had roughly eight times the likelihood of miscarriage compared to women whose levels were well managed. In the group with poor control, miscarriage rates ranged from about 12% to 22%, while women with good glycemic control saw rates between 0% and 3%. These numbers reinforce the same theme: the risk is real, but it responds powerfully to glucose management.
What to Do Before You Start Trying
Ideally, you’d start preparing three to six months before conception. The core goal is getting your A1C below 6.5% and keeping it there. If you’re on oral medications, your care team will likely review whether those are safe during pregnancy. Insulin is the most well-established treatment for managing blood sugar during pregnancy, and many women with type 2 diabetes transition to insulin before or early in pregnancy.
Folic acid is recommended for all women planning pregnancy, but the dose is different if you have diabetes. The standard recommendation for the general population is 0.4 mg per day. For women with pre-existing diabetes, several international guidelines recommend a much higher dose of 5 mg per day, starting two to three months before conception and continuing through the first 12 weeks. This higher dose helps reduce the elevated risk of neural tube defects associated with diabetes. Ask your provider which dose is right for you.
You’ll also want screening for any existing diabetes complications. Diabetic eye disease can worsen during pregnancy, particularly if blood sugar drops rapidly after being high for a long time. The degree of eye disease at conception, blood pressure, and how quickly glucose control improves all influence whether things progress. Getting an eye exam before pregnancy gives your team a baseline and helps plan monitoring. Kidney function should also be assessed, since pregnancy increases the workload on your kidneys and existing damage can accelerate.
Risks During Pregnancy
Even with good preparation, diabetes makes certain pregnancy complications more likely. Preeclampsia, a dangerous condition involving high blood pressure, occurs more often in women with type 1 or type 2 diabetes. Low-dose aspirin (81 mg daily) is recommended for women with pregestational diabetes, started between 12 and 16 weeks of gestation and continued until delivery, to reduce this risk.
High blood sugar during pregnancy also affects your baby’s growth. When extra glucose crosses the placenta, the baby’s pancreas responds by producing more insulin. That excess insulin acts like a growth hormone, causing the baby to grow larger than normal, a condition called macrosomia. Larger babies raise the chance of delivery complications, including the need for a cesarean section. After birth, the baby’s insulin-producing cells are still in overdrive, but the glucose supply from the placenta is suddenly gone. This can cause low blood sugar in the newborn during the first hours of life, which the medical team will monitor and manage.
Preterm birth is also more common in diabetic pregnancies. Some of this is medically indicated (doctors may recommend earlier delivery to reduce other risks), and some is spontaneous. Keeping blood sugar well controlled throughout pregnancy reduces the likelihood of all these complications.
What a Diabetic Pregnancy Looks Like Day to Day
Expect more frequent monitoring than a typical pregnancy. You’ll check blood sugar multiple times a day, and your care team will track your A1C throughout pregnancy. You’ll have more ultrasounds to monitor your baby’s growth and development. Eye exams typically happen each trimester if you have any existing retinopathy, or at least once during pregnancy if you don’t.
Your insulin needs will change as pregnancy progresses. During the first trimester, some women actually need less insulin and experience more low blood sugar episodes. In the second and third trimesters, hormones from the placenta increase insulin resistance, and your doses will likely go up significantly. This is normal and expected. Continuous glucose monitors can be especially helpful during pregnancy for catching highs and lows in real time.
Most women with well-managed diabetes deliver between 37 and 39 weeks. Your team will discuss timing based on how the pregnancy is progressing. After delivery, insulin requirements typically drop quickly, often returning to pre-pregnancy levels within days.
Type 1 vs. Type 2: Key Differences
Both types of diabetes carry similar pregnancy risks, but the practical experience differs. Women with type 1 diabetes are typically already familiar with insulin management and blood sugar monitoring, which can make the transition smoother. The challenge is that pregnancy hormones make blood sugar much harder to predict, and the tight control required can increase the frequency of dangerous lows.
Women with type 2 diabetes may be managing their condition with oral medications or lifestyle changes alone, which means pregnancy often brings a significant shift in treatment approach. Switching to insulin, learning to inject, and monitoring blood sugar more frequently can feel like a steep learning curve. Starting this process before conception, rather than after a positive test, gives you time to adjust.
Regardless of type, the outcomes data consistently show the same pattern: the closer blood sugar is to normal before and during pregnancy, the closer your risk profile gets to that of a woman without diabetes. Planning ahead is the most powerful thing you can do.