Despite advances, babies born to women with diabetes, especially women with poor diabetes control, are still at greater risk for birth defects.
High blood glucose levels and ketones (substances that in large amounts are poisonous to the body) pass through the placenta to the baby. These increase the chance of birth defects.
High blood glucose levels during the first trimester — the time when the baby's organs are forming — increase the risk of birth defects and also miscarriage. Since the baby's organs are completely formed by 7 weeks after your last period, when you may have just realized you are pregnant, it's important to get blood glucose levels under control before getting pregnant.
Because these early weeks are so important to your baby, you need to plan your pregnancy. If your blood glucose levels are not in your target range, work to bring your diabetes under control before getting pregnant. It is a good idea to be in good blood glucose control three to six months before you plan to get pregnant. You'll want to keep excellent blood glucose control during pregnancy, and after as well.
Some of the possible risks to the mother and baby if blood glucose levels are too high during pregnancy are:
- Risks for the baby
- Premature delivery
- Birth defects (not usually a risk for women with gestational diabetes)
- Macrosomia (having a large baby)
- Low blood glucose at birth (hypoglycemia)
- Prolonged jaundice (yellowing of the skin)
- Respiratory distress syndrome (difficulty breathing)
Risks for the mother
- Worsening of diabetic eye problems
- Worsening of diabetic kidney problems
- Infections of the urinary bladder and vaginal area
- Preeclampsia (high blood pressure usually with protein in the urine)
- Difficult delivery or cesarean section
Target blood glucose goals before getting pregnant
- Premeal (before eating): 60-119 mg/dl
- 1 hour after meals: 100-149 mg/dl
Your health care provider may have you use goals such as these, but check with your own team about your specific goals.
Along with getting your blood glucose levels in your target range, it's also important to establish a set of healthy lifestyle habits that will reduce the risk for complications and improve the health of your baby. For women with diabetes, this means an A1C as normal as possible (less than 7%), achieving or maintaining a healthy body weight, improving diet and exercise, and having a pre-pregnancy exam.
A pre-pregnancy exam by your doctor typically includes: measuring your A1C level to make sure blood glucose levels are under control. It also will include an assessment of any complications, such as high blood pressure, heart disease, and kidney, nerve, and eye damage. If you have type 1 diabetes, your doctor will likely check the function of your thyroid.
You should also review all you medications and supplements with your doctor to make sure they are safe to continue using with pregnancy. Drugs commonly used to treat diabetes and its complications may not be recommended in pregnancy, especially statins, ACE inhibitors, ARBs, and most noninsulin therapies.
While you are getting your blood glucose levels under control and your healthy lifestyle habits where you want them to be, its important to have a family planning method in place. Women with diabetes have the same birth control options as women without diabetes. The pill, the intrauterine device (IUD), implants, barrier methods such as a diaphragm or condoms, and spermicides are all ways to reduce the risk of unplanned pregnancy. Which method you choose will depend on your own health history and you and your partner's preferences.
If you have any concerns, be sure to bring them up with your health care team.