If you have type 2 diabetes, the American Diabetes Association recommends planning pregnancy with your care team, aiming for an A1C under 6.5% if it can be reached safely, and reviewing medications — especially GLP-1 drugs, which should be stopped before pregnancy. If you have prediabetes or have had gestational diabetes, the most useful single step is getting screened before you conceive, so nothing is discovered for the first time in early pregnancy.
Start with a number, not a guess
Why this is a different conversation than type 1
Type 1 diabetes usually announces itself. Type 2 diabetes and prediabetes often do not. The CDC estimates that more than 2 in 5 American adults have prediabetes, and many people find out only because a routine test happens to be ordered. For people hoping to conceive, that can mean the first glucose test of their adult life is at a prenatal visit — after the weeks when glucose matters most for a baby’s development.
The ADA’s 2026 pregnancy chapter addresses this head-on. It recommends preconception screening for people who have had gestational diabetes, notes that people with prediabetes or prior gestational diabetes need preconception evaluation for as long as they could become pregnant, and says that if someone was not screened before conception, testing should be done before 15 weeks of pregnancy.
The good news: type 2 diabetes and prediabetes respond to planning. A few months of attention before conception can change the starting line.
Know your numbers
These are the standard diagnostic ranges the ADA uses outside of pregnancy. A diagnosis usually needs to be confirmed with a repeat test on another day unless glucose is very high or you have classic symptoms.
| Test | Typical range | Prediabetes | Diabetes |
|---|---|---|---|
| A1C | Below 5.7% | 5.7%–6.4% | 6.5% or higher |
| Fasting plasma glucose | Below 100 mg/dL | 100–125 mg/dL | 126 mg/dL or higher |
| 2-hour oral glucose tolerance test | Below 140 mg/dL | 140–199 mg/dL | 200 mg/dL or higher |
Who should ask for testing before trying? The CDC lists risk factors for prediabetes that include having had gestational diabetes, having given birth to a baby over 9 pounds, having polycystic ovary syndrome (PCOS), being 45 or older, being overweight, being physically active fewer than three times a week, and having a parent or sibling with type 2 diabetes. Some racial and ethnic groups also carry higher risk. If any of these apply, an A1C at your preconception visit is a reasonable request.
If you have type 2 diabetes
The core preconception recommendations are the same ones the ADA gives for all pre-existing diabetes:
- Preconception counseling as part of routine diabetes care, and effective contraception until treatment and A1C are optimized (Recommendations 15.1–15.2).
- An A1C goal under 6.5% (48 mmol/mol) if it can be reached without significant hypoglycemia, to lower the risk of congenital anomalies, preeclampsia, large babies, and preterm birth (15.3).
- A complications screen: dilated eye exam, kidney tests (creatinine and urine albumin-to-creatinine ratio), lipid panel, thyroid test, and foot exam.
- A prenatal vitamin with at least 400–800 μg folic acid and 150 μg potassium iodide. In the UK, NICE-based NHS guidance advises a 5 mg prescription folic acid dose for people with diabetes, started at least three months before trying — so ask your clinician which dose applies to you.
The treatment usually changes in pregnancy
Many people with type 2 diabetes manage with pills or non-insulin injections. Pregnancy is different. The ADA states that insulin is the preferred medication for type 2 diabetes in pregnancy (15.17), that metformin and glyburide should not be used as first-line agents because both cross the placenta (15.21), and that other oral and non-insulin injectable glucose-lowering medications lack long-term safety data in pregnancy.
That does not mean every pill has to stop the day you start trying. The ADA notes, for example, that metformin started before pregnancy can be continued and then stopped by the end of the first trimester to avoid an abrupt rise in glucose, and that it should not be used in people with hypertension, preeclampsia, or risk of fetal growth restriction. These are decisions for your prescriber, ideally made before conception so you are not switching regimens in the middle of first-trimester nausea.
The GLP-1 question
Semaglutide, tirzepatide, and related drugs are now common for both type 2 diabetes and weight. The ADA’s guidance is direct: GLP-1 receptor agonists and dual GIP/GLP-1 agonists should be discontinued before pregnancy, and contraception should be used while taking them.
- Semaglutide’s U.S. label advises stopping at least two months before a planned pregnancy.
- The U.S. tirzepatide label gives no specific interval; the ADA notes the Canadian label advises stopping at least one month before.
- The ADA adds that it may take several months to clear the drug and get glucose to target on a new regimen, and that weight regain is a known risk after stopping.
- Tirzepatide can make birth control pills less effective. The manufacturer advises switching to a non-oral method or adding a barrier method for four weeks after starting it and for four weeks after each dose increase.
Put together, the realistic sequence is usually: talk with your prescriber, plan a replacement (often insulin), stop the GLP-1 with contraception still in place, let glucose settle on the new regimen, then start trying. This can feel like losing ground, especially if the medication has helped a lot. Naming that frustration with your clinician is worthwhile; the plan can include support for the transition.
If you have prediabetes or had gestational diabetes
Prediabetes is not a pregnancy contraindication. It is a signal to use the time before conception well.
- Get a baseline now and a repeat before you start trying, so you know whether you are heading toward or away from diabetes.
- Consider a structured lifestyle program. The CDC-led National Diabetes Prevention Program reports that participants can lower their risk of developing type 2 diabetes by 58%. Programs take months, which fits a preconception timeline.
- If you had gestational diabetes before, the ADA recommends screening before your next pregnancy and lifelong screening every 1–3 years. Many people miss the postpartum glucose test; if you did, this is the moment to catch up.
- Plan for early testing in pregnancy if you were not screened beforehand. The ADA describes a cautious approach to mildly elevated glucose found early in pregnancy, including nutrition counseling and fasting glucose checks, because the evidence on treatment benefit below the diabetes threshold is still uncertain.
A note on metformin and PCOS
Some people with PCOS take metformin while trying to conceive. The ADA says metformin used for PCOS and ovulation induction should be stopped by the end of the first trimester (15.22). If this applies to you, ask your prescriber now when they want you to stop, so it is decided before a positive test rather than after.
A realistic three-to-six-month plan
NHS diabetes-and-pregnancy guidance suggests allowing 6–12 months for planning when diabetes is involved. Not everyone needs that long, but most people need more than a few weeks.
- A1C (and a repeat if the first result was borderline).
- Medication review: glucose-lowering drugs, blood pressure, cholesterol, weight medications, supplements.
- Eye exam and kidney labs if you have diabetes.
- Prenatal vitamin with folic acid at the dose your clinician recommends.
- Blood pressure check — chronic hypertension often travels with type 2 diabetes.
- A named person to call the day you get a positive test.
- The general items on our TTC checklist.
If a partner is involved, this is a good shared project. Meals, movement, and appointment logistics are easier as a team, and a partner who also has diabetes or prediabetes benefits from the same checkup.
The human side of it
Type 2 diabetes carries stigma that type 1 mostly does not — the unfair assumption that it is a personal failing. That stigma can make people avoid testing, or feel ashamed when a number comes back high. Genetics, PCOS, medications, sleep, stress, and access to food and care all shape glucose. A diagnosis before pregnancy is not a judgment. It is the best possible time to find out, because it is the time when you have the most options.
If you are worried that diabetes is slowing conception itself, the usual timelines for seeking help still apply — and with a known medical condition, it is reasonable to ask sooner. See when to see a fertility specialist.
Frequently asked questions
Should I get tested for diabetes before trying to conceive?
If you have risk factors such as prior gestational diabetes, PCOS, a family history of type 2 diabetes, or overweight, it is reasonable to ask for an A1C or fasting glucose test. The ADA recommends preconception screening after gestational diabetes and testing before 15 weeks of pregnancy if it did not happen beforehand.
Can I keep taking metformin while trying to conceive?
Sometimes. The ADA notes metformin started before pregnancy can be continued and stopped by the end of the first trimester, but it is not a first-line pregnancy medication and is not recommended with hypertension, preeclampsia, or growth-restriction risk. Your prescriber should decide your plan.
When should I stop Ozempic, Wegovy, Mounjaro, or Zepbound before pregnancy?
The ADA says GLP-1 and GIP/GLP-1 medications should be stopped before pregnancy, with contraception used while taking them. Semaglutide’s label advises stopping at least two months before a planned pregnancy. Plan the timing and replacement treatment with your prescriber.
What A1C should I have before getting pregnant with type 2 diabetes?
The ADA recommends an A1C under 6.5% before conception if it can be achieved without significant hypoglycemia. Your team may individualize the goal.
Is prediabetes a reason not to get pregnant?
No. Prediabetes is a reason to plan: get a baseline test, use the preconception months for lifestyle changes, and make sure glucose is checked early in pregnancy.
Sources & guidance
- ADA Professional Practice Committee. 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2026. Diabetes Care 2026;49(Suppl 1)
- ADA: Blood Glucose & A1C — Diagnosis
- CDC: Prediabetes — Your Chance to Prevent Type 2 Diabetes
- Cambridge University Hospitals NHS: Diabetes and pregnancy — type 2 diabetes
- Lilly Medical: Can tirzepatide be used with oral contraceptives?