As more women navigate fertility treatment alongside metabolic conditions such as insulin resistance and diabetes, the need for clear, evidence-based guidance has become increasingly important. Dr Reji Mohan, associate professor in the department of reproductive medicine at the Sree Avittom Thirunal Hospital for Women and Children in Thiruvananthapuram, offers practical insights drawn from years of clinical experience in a high-volume public healthcare setting. In conversation with Unnikrishnan S, he explains how metabolic health influences pregnancy outcomes, and what patients can realistically do to manage risks while undergoing treatment.
What is the primary target for metabolic stability when preparing for or undergoing pregnancy?
The aim is to keep blood glucose levels as close to normal as safely possible before conception and during pregnancy. A fasting blood glucose level below 95 mg/dL is generally recommended. Screening for insulin resistance or glucose intolerance is done using tests such as the one-hour glucose challenge test (GCT) or a more detailed oral glucose tolerance test (OGTT).
In a standard one-hour GCT with 50g of glucose, values below 140 mg/dL are typically considered normal. If further testing is needed, a 75g OGTT may be done, where two-hour values should remain within acceptable limits based on clinical guidelines.
Is physical activity encouraged for women at risk of insulin resistance who are trying to conceive? Does this change during pregnancy?
Yes, physical activity is strongly recommended. Regular exercise improves insulin sensitivity and helps regulate blood sugar levels. Women trying to conceive are generally advised to get at least 150 minutes of moderate exercise per week, such as brisk walking, cycling, or swimming, along with light strength training. During pregnancy, exercise remains beneficial but should be adapted. Starting a new high-intensity routine is not advised. Brisk walking and light prenatal exercises are commonly recommended.
What kind of diet is recommended for pregnant women at risk of insulin resistance?
The focus is on balanced, portion-controlled meals rather than strict calorie restriction. A practical approach is the “plate method,” where one-quarter of the plate includes complex carbohydrates (preferably low glycaemic index), half consists of non-starchy vegetables, and one-quarter is lean protein.
There is often anxiety about the safety of medications. How is this addressed?
Medication safety is a top priority. If a woman is on drugs that are not suitable for pregnancy, they are reviewed and adjusted before conception.
Insulin is considered safe during pregnancy and is often the preferred treatment when medication is required. All treatment decisions should be guided by a doctor, and patients are advised not to stop medications on their own.