Have Diabetes and Thinking of Getting Pregnant?

Long before you're ready to take an at-home pregnancy test and pray that the stick turns blue, you should start planning for your baby.

Before becoming pregnant, it's crucial for a woman with diabetes to get her hemoglobin A1C within the normal range, or risk both miscarriage and birth defects.  She should strive to have blood sugar levels within the normal range, too, so she can give birth to a healthy baby.

Here's what you need to know when you are considering getting pregnant.

  • The good news is that diabetic women who have a normal hemoglobin A1C carry no additional risk to the pregnancy than women without diabetes, says Dr. Ellen Landsberger, associate professor of obstetrics and gynecology at the Diabetes Center at Montefiore Medical Center in New York City.
  • Make an appointment for preconception counseling with your doctor to assess your blood glucose control, advises Landsberger. "You'll sit down with a high-risk obstetrician/gynecologist to learn the steps that you should take to make sure you have a healthy pregnancy," she explains.
  • If you have type 2 diabetes and are on oral medications, you may be taken off these medications and started on insulin, Landsberger says. Many of the oral medications are not recommended for use during pregnancy, so insulin therapy fills in, just for the duration of the pregnancy. "It's better for someone with type 2 to make the switch to insulin before the pregnancy," Landsberger says. "This way, she can become accustomed to the monitoring that is inherent with being on insulin"
  • If you've had diabetes for a long time and are on certain medications for renal disease, these, too, may either be stopped or switched to a different medication that is considered safe during pregnancy. "If you are on medication because you have protein in the urine, it may be stopped during pregnancy," Landsberger says.
  • Once you become pregnant, you will be asked to monitor your blood sugar levels extra closely, says Carlos Hamilton, MD, professor of internal medicine at the University of Texas Health Science Center in Houston, Texas. "Women whose blood sugar is not extremely well controlled tend to have an increased incidence of congenital malformations in the baby," he says. "And they tend to be very large babies, or to have breathing troubles at birth."
  • Even if you are using syringes, you may be asked by your doctor to get an insulin pump, Hamilton says, since it's possible to maintain tighter blood sugar control with a pump.
  • Many women require less insulin early in the pregnancy, Landsberger explains. They may need more insulin later on in the pregnancy, and it's easier to deliver that insulin via the pump.
  • You also will be advised to closely monitor your blood pressure, Hamilton says. "The doctor will monitor your blood pressure and may even recommend at some point in the pregnancy that you take off work and keep your feet elevated," he says. "Bed rest may be recommended for the last few weeks of pregnancy."
  • With all pregnancies, you will be advised to take a prenatal vitamin, and to stop drinking alcohol, if you haven't already.