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Pregnancy is a time filled with excitement, hopes, and plans for the future. But if you’ve been told you have pre-diabetes, it is normal to feel a little more anxious. Pre-diabetes means your blood sugar levels are higher than normal, but not yet in the range of diabetes. While this may not feel like a major concern on its own, during pregnancy, it becomes something that needs close attention.

Even slightly elevated blood sugar in early pregnancy can affect both your health and your baby’s development. But here’s the reassuring part: with the right care and early planning, you can have a safe pregnancy and a healthy baby.

At Sunway Medical Centre Velocity, we care deeply about supporting women through high-risk pregnancies. Dr Lim Kim Piow, Consultant Endocrinologist and Internal Medicine Physician, and Dr Gayathri Mariappa, Consultant Obstetrician & Gynaecologist and Maternal-Fetal Medicine Specialist, work closely with expectant mothers to help manage pre-diabetes through tailored care, combining nutrition, monitoring, lifestyle changes, and regular check-ups.

Understanding the Risks — and Why Early Care Matters

Pregnancy puts extra demands on your body, especially how it handles sugar. For mothers with pre-diabetes, there’s a higher chance of developing gestational diabetes (GDM), a temporary form of diabetes that can appear during pregnancy. There’s also a greater risk of high blood pressure, pre-eclampsia, or early delivery if blood sugar isn’t well managed.

For your baby, elevated blood sugar early in pregnancy can affect organ development. Later in pregnancy, it may cause the baby to grow too large (a condition called macrosomia), which can make delivery more difficult and may increase the chances of needing a caesarean section. After birth, babies born to mothers with uncontrolled blood sugar may also experience low blood sugar(hypoglycemia) and are more likely to develop obesity or type 2 diabetes later in life.

These risks may sound overwhelming, but they’re not inevitable. With the right care and commitment, many of these complications can be avoided.

Planning Ahead: Before You Conceive

If you have pre-diabetes and are planning to become pregnant, it’s important to start preparing your body early. This includes getting your blood sugar levels under control, reviewing your current medications with your doctor, and addressing any other health conditions that might affect pregnancy, such as high blood pressure, cholesterol issues, or thyroid problems.

It is recommended to take taking 5 mg of folic acid daily for at least three months before pregnancy. This helps protect your baby from neural tube defects, which affect the brain and spine and are more common in women with elevated blood sugar.

By planning early and working with your healthcare team, you’re giving yourself the best chance for a smooth, healthy pregnancy.

Eating Well with Purpose: Nutrition as Medicine

Food plays an incredibly important role in managing pre-diabetes during pregnancy. This isn’t about dieting or restriction — it’s about learning how to nourish your body in a way that keeps your blood sugar stable while supporting your baby’s growth.

At Sunway Medical Centre Velocity, we encourage mothers to follow a carbohydrate-controlled meal plan developed with a registered dietitian. This is called Medical Nutrition Therapy (MNT), and it’s a personalised approach that helps you understand which foods work best for your body.

You’ll learn how to balance your meals with slow-digesting carbs, lean proteins, healthy fats, and plenty of fibre, all while ensuring you get the nutrients you and your baby need.

Daily Monitoring: Understanding Your Body’s Signals

Once you’re pregnant, keeping track of your blood sugar should become a daily habit. Most mothers with pre-diabetes are asked to check their glucose several times a day, before meals, after meals, and sometimes in between. This helps your care team see how your body is responding and make adjustments if needed.

You’ll also have regular blood tests like HbA1c (which shows your average sugar over a few months), fasting sugar tests, and possibly an oral glucose tolerance test. These tests, along with blood pressure checks and weight monitoring, help your doctors keep both you and your baby on the right track.

Dr Gayathri shares that many mothers feel empowered once they get used to this rhythm — they feel more in control and more connected to their pregnancy journey.

Moving Your Body, Supporting Your Health

Exercise is one of the most helpful tools for managing pre-diabetes, and it’s safe during most pregnancies. Gentle activities like walking, swimming, and prenatal yoga can help improve how your body uses insulin, lower your blood pressure, and reduce stress.

If you’re planning your pregnancy and carrying extra weight, even a modest weight loss of 5–10% before conception can help reduce the risk of complications. Once you’re pregnant, the focus shifts to maintaining healthy weight gain and staying active in a way that supports your energy and mood.

Looking at the Bigger Picture: Managing Comorbidities

Pre-diabetes rarely exists alone. It often comes with other health conditions such as type 2 diabetes, high blood pressure, high cholesterol, or sleep problems like obstructive sleep apnoea. These are called comorbidities, and they can increase the risk of pregnancy complications if not properly managed.

We encourage women with pre-diabetes to take a whole-person approach. This means working with a team that looks at all aspects of your health, not just your blood sugar. At Sunway Medical Centre Velocity, our patients benefit from a team of Endocrinologists, Obstetricians and Gynaecologists and Dietitians, who coordinate care every step of the way.

If Medication or Insulin Is Needed

Sometimes, even with lifestyle changes, blood sugar levels remain too high. If that happens, your doctor may recommend switching from tablets to insulin, which is safe to use during pregnancy. Insulin allows for more precise control and doesn’t cross the placenta to your baby.

Dr Lim explains that starting insulin doesn’t mean you’ve failed,  it’s simply one of the tools available to protect your baby’s health and keep your pregnancy on track.

After Baby Arrives: What Comes Next?

The care doesn’t stop after birth. Women who had pre-diabetes during pregnancy are at a higher risk of developing type 2 diabetes in the future, especially in the first few years postpartum. That’s why it’s important to continue monitoring your health after delivery.

Your doctor will usually recommend a glucose test 6–12 weeks after birth, and regular follow-up tests every 1–3 years. A dietitian can help guide you through postpartum nutrition, and your care team will also advise on family planning and safe birth spacing to give your body time to recover.

When to Contact Your Doctor

If you notice that your blood sugar readings are staying too high, if your baby’s movements feel reduced, or if you’re experiencing symptoms like blurred vision, excessive thirst, or unusual fatigue — contact your care team right away. These may be signs that your treatment plan needs adjusting.

Also, if your pregnancy is unplanned and you have pre-diabetes, reach out to your doctor as soon as possible. Early action can make a big difference.

A Healthier Pregnancy, One Step at a Time

Pregnancy with pre-diabetes comes with extra responsibilities, but you’re not alone. With good planning, regular monitoring, and a team of supportive specialists, you can have a healthy pregnancy and protect your baby’s future.

At Sunway Medical Centre Velocity, our team is here to support you from preconception to postpartum. With the care of specialists like Dr Lim Kim Piow and Dr Gayathri, we’ll help you navigate every stage of your pregnancy with confidence and peace of mind.