Women with type 2 diabetes face multiple concerns before and during the early stages of planning a pregnancy, and clinicians must consider the impact of type 2 diabetes and treatment on pregnancy, in addition to helping patients overcome the concerns that are commonly associated with female motherhood. What are some important medication considerations for women with type 2 diabetes when considering pregnancy? The American Diabetes Association (ADA) offers some recommendations that may help clinicians with preconception care for women with type 2 diabetes. The key messages are as follows: HbA1c should be controlled as close to the normal range as possible (HbA1c < 7%) prior to planning a pregnancy. Because pregnancy can make glycemic control more difficult, many women with type 2 diabetes will request that their treatment regimen be switched to basal/mealtime insulin therapy to ensure adequate glycemic control, as well as oral hypoglycemic medications that fall into the pregnancy class B medication class in the table below: Many medications commonly used in patients with type 2 diabetes are not safe for use in pregnancy: statins are classified as Pregnancy Category X drugs and should be discontinued prior to pregnancy. In fact, almost all lipid-lowering drugs are listed as contraindicated during pregnancy. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are commonly used to lower blood pressure and protect the kidneys in patients with type 2 diabetes mellitus. ACEIs are classified as pregnancy category X drugs, and ARBs are classified as category C drugs during the early stages of pregnancy and category D drugs during the middle and late stages of pregnancy. These drugs should also be discontinued before pregnancy or replaced with other drugs (e.g., methyldopa, which is mostly used for blood pressure lowering treatment in pregnancy). Women with type 2 diabetes should be evaluated for comorbidities of retinopathy, nephropathy, neuropathy, and cardiovascular disease before pregnancy. If these complications are present, they should be treated promptly.