Many women begin pregnancy with preexisting problems, such as diabetes. In fact, about one in every 100 women of childbearing age has some form of diabetes. This includes Type 1 (insulin dependent) and Type 2 (noninsulin dependent) diabetes. In either case, most women with diabetes can have a successful pregnancy and healthy baby if the condition is well controlled. If you have diabetes, it is important for you to see your doctor before conceiving to discuss your care. You should have good control of your blood sugar levels for at least several weeks before becoming pregnant. This is because you might not even know you are pregnant until the baby has been growing for two to four weeks.

The baby's organs begin to form very early in pregnancy, and development can be affected by a mother's poorly controlled blood sugar levels. High blood sugar levels early in the pregnancy can increase the risk for birth defects. Good control of blood sugar is just as important during the pregnancy as it is before pregnancy to decrease risk of other potential problems.

Weighing the Risks

If diabetes is not well controlled before and during pregnancy, problems that may arise include a higher risk of birth defects, a very large baby, pre-eclampsia, miscarriage, urinary tract infections, respiratory problems for the baby after birth, and too much amniotic fluid surrounding the baby, which can lead to preterm labor. Beyond possible problems for the baby, people who do not control their diabetes can end up with both short- and long-term health problems.

If you have diabetes, it is essential to meet with your doctor before you become pregnant. You may be advised to wait to become pregnant until you have your blood sugar under control. This can take time, so be patient. Your diabetes health-care provider needs to first determine if your diabetes is controlled well enough to decrease the risk for possible complications during pregnancy. A blood test, called a glycosylated hemoglobin test (HbA1c), is used to evaluate how well your diabetes has been controlled over the past six to twelve weeks. This blood test may also be used during pregnancy to monitor how well you are controlling your blood sugars.

Your diabetes health-care provider may also perform other tests before deciding that it is safe for you to conceive. These tests may include a urinalysis to screen for any possible diabetic kidney complications, a blood test to evaluate cholesterol and triglyceride levels, and an eye exam to screen for common diabetic problems including glaucoma, cataracts, and retinopathy. All of these tests can help your health-care provider determine whether your diabetes is under control. Your doctor will help you to properly monitor your blood sugar levels both before and during your pregnancy.

Reducing Your Risks

To better control your diabetes, you should monitor and record your blood sugar regularly, make necessary changes to your diet, take prescribed medications and/or insulin as directed, and exercise on a regular basis. It is also vital to achieve a healthy weight. Type 2 diabetes is very prevalent among people who are overweight or obese, and achieving a healthy weight often decreases or eliminates blood sugar problems. All these factors can lead to better control of your condition.

It is also important to take a prenatal vitamin that contains 1,000 mcg of folic acid at least one month or more before becoming pregnant. Women with preexisting diabetes are already at a higher risk for having a baby with neural tube defects, so folic acid intake is essential. A registered dietitian can work with you on your dietary intake as well as weight issues, which can both greatly affect not only your blood sugar levels but also the effectiveness of your medication or insulin.

Treatment Plan

If you have either type of diabetes, you should follow a diet and treatment plan during pregnancy that has been designed specifically for you. You should continue with nutritional counseling as your pregnancy progresses so that diet modifications can be made if necessary, and nutritional education can continue. Calorie needs during pregnancy vary among different women and depend on weight, height, stage of pregnancy, age, and level of activity.

However, most women require the standard 300 extra calories (after the first trimester), diabetic or not. If you are like most pregnant diabetics, following the Food Guide Pyramid and eating small meals throughout the day will help you gain the recommended number of pounds. Again, your meal plan will depend on your individual situation, including the insulin regimen that you are on. A dietitian can help you to plan out a diet that is right for you. Regular exercise, with your doctor's permission, can help to control blood sugar levels.

If you take oral glycemic medications to control your blood sugar, your doctor will probably switch you to insulin for the time before you conceive and during your pregnancy. The safety of oral glycemic medications during pregnancy has not yet been completely established and may increase the risk of birth defects. Insulin requirements will generally change during pregnancy. In the first half of pregnancy, insulin requirements may decrease because of the baby's use of glucose. In the second half of pregnancy, around the fifth month, hormone changes can create an increased need for insulin. At this point, some diabetic women may need insulin even if their pre-pregnancy condition was adequately controlled with diet alone.