Having preexisting diabetes when you get pregnant will make your pregnancy more complicated. However, you'll minimize the risk to your baby if you work closely with your endocrinologist and obstetrician. The key is controlling your blood sugar levels. According to the March of Dimes, if a woman with diabetes has well-controlled blood sugar levels before conceiving, her chances of having a healthy baby are nearly the same as those of a woman without diabetes.
Women with preexisting diabetes do have a higher chance of miscarriage and of having a baby who has birth defects. They also have a greater risk of having a very large baby -- 10 pounds or bigger -- who is more likely to be injured during delivery than a smaller baby. Such problems tend to occur in women whose blood sugar is out of control; that's why blood sugar control before and during pregnancy is absolutely crucial. (If you take oral diabetes medications, your doctor will probably switch you to injected insulin because it is not known if oral diabetes medications taken in the 1st trimester can cause birth defects.)
Taking folic acid before conception and during the first few weeks of pregnancy is even more important for women with diabetes than for women without diabetes because babies of diabetic women have an increased risk of birth defects. It's best to check with your doctor about folic acid before you conceive; women with diabetes may be advised to take a higher-than-normal dose. (Don't do this without your doctor's recommendation.)
Note: Preexisting diabetes is different from gestational diabetes, which occurs during pregnancy and usually ceases after delivery.
Originally published in You & Your Baby: Pregnancy.
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