Carrie Madormo, RN, MPH, is a freelance health writer with over a decade of experience working as a registered nurse in a variety of clinical settings.
Miscarriage is, unfortunately, very common. The risk is greater if you have type 2 diabetes. Type 2 diabetes causes physical changes in the body, like high blood sugar and insulin levels, that put pregnancies at risk. 
If you are hoping to become pregnant, talk with your healthcare provider about any changes you can make to lower your risk.
This article provides an overview of why type 2 diabetes raises the risk of miscarriage and what to do about it.  

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Pregnancy changes your body’s energy needs, affecting type 2 diabetes. The body’s need for insulin tends to go up during pregnancy. This is especially true during the third trimester because of changing hormone levels produced by the placenta.
Pregnancy and pregnancy loss can also affect your risk for diabetes. A review found people who experienced pregnancy loss were at an increased risk for developing type 2 diabetes later in life. 

People with type 2 diabetes are at an increased risk of high blood glucose levels (hyperglycemia). High blood glucose can harm a developing baby in the first few weeks of pregnancy. This damage can occur before you know you are pregnant. 
High blood glucose levels during pregnancy raise the risk of:
High blood glucose can also increase the risk of vision problems, kidney disease, and preeclampsia (high blood pressure) in pregnant people. Smoking increases these risks. 

It is safest to get your glucose levels into a healthy range before becoming pregnant. If you plan to become pregnant soon, talk with your healthcare provider about your risks and how to address them.

High insulin levels can also raise the risk of miscarriage in those with type 2 diabetes. One study found that insulin may be toxic to early placenta cells. This can damage the placenta, which may cause a miscarriage.
People with type 2 diabetes may experience high insulin levels because of insulin resistance, which occurs when the cells do not use insulin effectively. This causes insulin to build up in the blood rather than enter the cells normally. When the cells cannot use insulin, the pancreas makes more to try and compensate. 
The oral medication Glucophage (metformin) is a safe treatment for high insulin levels during pregnancy.

Pregnant people with type 2 diabetes are at an increased risk of the following health concerns:
Many people with type 2 diabetes have other health conditions, such as obesity or autoimmune disease. These factors can also raise the risk of miscarriage. 
It is estimated that up to 25% of all pregnancies end in miscarriage. Chromosomal abnormalities cause about 50% of spontaneous pregnancy loss. 
Obesity is a known risk factor for miscarriage. The risk of pregnancy loss in individuals who are obese is 25% to 37%. Individuals in this weight range are also at increased risk of premature birth, congenital abnormalities, and neonatal death. 
Another miscarriage risk factor is advanced maternal age. Pregnant people between the ages of 20 and 30 have an 8.9% risk of pregnancy loss, while pregnant people over age 40 have a 74.7% risk.
Lifestyle factors such as smoking, consuming large amounts of caffeine, and alcohol or substance abuse raise the risk of miscarriage. 

Pregnant people who are obese are at increased risk of:
The best way to lower the risk of miscarriage is to manage type 2 diabetes effectively. This means finding ways to keep your blood glucose and insulin levels in the healthy ranges.
If you are not pregnant, this is the best time to get your diabetes under better control. Talk with your healthcare provider about steps you can start taking right away.
Diet and exercise are vital factors in managing type 2 diabetes. It may be helpful to meet with a dietitian to plan meals and learn which foods to eat and when. Focus on healthy options like vegetables, fruits, whole grains, lean proteins, and healthy fats. 
Getting daily exercise is another way to manage diabetes. Physical activity causes your body to use up extra blood sugar for energy. It can also ease many of the discomforts of pregnancy, such as muscle aches and constipation. 
Managing type 2 diabetes care while pregnant can be a challenge. Talk with your healthcare provider about what actions you can take at home to have a healthy pregnancy.
Gaining a healthy amount of pregnancy weight can lower some of the risks of pregnancy. Opt for healthy foods daily, and aim for at least 30 minutes of physical activity. 
If you require insulin or oral medications to manage your blood sugar levels, take them as directed and continue to monitor your blood glucose throughout the day.

Experiencing a miscarriage can be devastating, and everyone reacts differently. Consider talking with a mental health provider or support group if needed. Only you can know when you’re ready to try to become pregnant again. Most healthcare providers believe it is safe to try again after one normal period.
Miscarriage is relatively common, and people with type 2 diabetes are at increased risk. This is because elevated blood glucose and insulin levels affect a growing fetus and placenta. To lower your risk of miscarriage, focus on managing your diabetes as effectively as possible. A healthy diet, daily exercise, and safe weight gain can contribute to a healthy pregnancy.
Attempting to manage a chronic health condition while pregnant is overwhelming. You may be feeling anxious about the risk of miscarriage. It may be helpful to remember that there are steps that you can take to lower your risk of pregnancy complications. Ask your healthcare provider about the right treatment plan for you, and consider meeting with a dietitian for nutrition support. 
Insulin does not cross the placenta and is considered safe during pregnancy. Talk with your healthcare provider about your body’s insulin needs during pregnancy.

Your body’s needs may change during pregnancy, so staying in close contact with your healthcare team is important. For example, many pregnant people find that their insulin needs go up during pregnancy, especially in the third trimester.

Risk factors for gestational diabetes include:

American College of Obstetricians and Gynecologists. Early pregnancy loss.
Centers for Disease Control and Prevention. Type 1 or type 2 diabetes and pregnancy.
Cundy T, Gamble G, Neale L, et al. Differing causes of pregnancy loss in type 1 and type 2 diabetes. Diabetes Care. 2007;30(10):2603-2607. doi:10.2337/dc07-0555
American Diabetes Association. Prenatal care.
Egerup P, Mikkelsen AP, Kolte AM, et al. Pregnancy loss is associated with type 2 diabetes: a nationwide case-control study. Diabetologia. 2020;63(8):1521-1529. doi:10.1007/s00125-020-05154-z
National Institute of Diabetes and Digestive and Kidney Diseases. Pregnancy if you have diabetes
Vega M, Mauro M, Williams Z. Direct toxicity of insulin on the human placenta and protection by metformin. Fertil Steril. 2019;111(3):489-496.e5. doi:10.1016/j.fertnstert.2018.11.032
Centers for Disease Control and Prevention. Type 1 diabetes and pregnancy.
Malasevskaia I, Sultana S, Hassan A, et al. A 21st century epidemy-obesity: and its impact on pregnancy loss. Cureus. 2021;13(1):e12417. doi:10.7759/cureus.12417
National Institute of Diabetes and Digestive and Kidney Diseases. Managing & treating gestational diabetes.
Stanford Medicine. Coping with miscarriage.
Centers for Disease Control and Prevention. Gestational diabetes.
By Carrie Madormo, RN, MPH
Carrie Madormo, RN, MPH, is a health writer with over a decade of experience working as a registered nurse. She has practiced in a variety of settings including pediatrics, oncology, chronic pain, and public health.

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