Diabetes and Pregnancy: Protect Yourself, Protect Your Baby

You've decided you want to become a mom and are hoping to become pregnant soon. But if you have diabetes, it's important your blood sugar is under control before you even try to conceive.

"Your level of glycemic control will really dictate how well the pregnancy goes," says Cynthia Gyamfi, MD, an OB/GYN at NewYork-Presbyterian Hospital/Columbia University Medical Center in New York City. "Keeping your glycemic control to optimal levels really decreases your chances of problems. It's all a matter of being well-controlled and not having erratic blood sugars."

There's good news for women who are vigilant about their blood sugar control, says Joel Zonszein, MD, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City. "The outcome is excellent when the patient is well-controlled," he says.

Poor control of diabetes during pregnancy can result in grave problems. Ketones, which in large amounts can be poisonous to the baby, pass through the placenta and increase the chances of birth defects. A baby's organs are forming in the early weeks of pregnancy and are finished forming seven weeks after your last period. This can be before a woman even knows she is pregnant, so it's crucial to be in good control before you conceive. The American Diabetes Association recommends that you be in good control of your blood sugars for three to six months before attempting to get pregnant.

Macrosomia, a term used to describe a newborn with an excessive birth weight, is another possible risk. Miscarriage and premature delivery also can occur when diabetes is not controlled.

The mother's health can be affected, too, potentially resulting in worsening of diabetic kidney and eye problems, as well as preeclampsia (high blood pressure) and a difficult delivery.

For a healthy pregnancy:

  • Get a pre-pregnancy checkup from your doctor. For one thing, you'll be able to find out what your hemoglobin A1C is. "This will tell you how well you've been controlling your condition," Gyamfi says. "A score of less than 7 is an ideal starting place." At this visit, you'll also learn if you have high blood pressure, heart disease, eye damage, or kidney damage.
  • Try to optimize blood sugar levels. Your goal, according to the American Diabetes Association, is to have your pre-meal blood glucose be between 60 and 118, and your post-meal blood sugar be between 100 and 149.
  • Consider making an appointment with a maternal-fetal specialist before becoming pregnant, Gyamfi says.
  • Ask if you'll be put on insulin (if you have pre-pregnancy diabetes and are on oral agents). Often, a woman is advised to switch over to insulin if she had diabetes before getting pregnant, says Gyamfi.
  • Be proactive in your care, advises Gyamfi. "You can have a perfectly normal pregnancy," she says. "And with very close monitoring and frequent visits to the doctor, you can have a healthy baby."



"Before Pregnancy." Living with Diabetes. American Diabetes Association