Women with diabetes have unique health concerns when it comes to pregnancy. Babies born to mothers with diabetes are at an increased risk for birth defects, premature birth, high birth weight, breathing problems, and low blood sugar levels (hypoglycemia). Mother with diabetes are also at risk for eye and kidney problems, infections, and high blood pressure.

Developing a blood glucose management plan will help give you and give your baby the best start.

Before You Become Pregnant

A baby’s organs form during the first trimester. Starting healthy habits before you become pregnant can help to reduce the risk of birth defects and miscarriage. By gaining control of your diabetes for 3-6 months before you become pregnant, you will increase the likelihood of a healthy pregnancy.

Begin by scheduling a pre-pregnancy appointment with your doctor to talk about your plans to become pregnant and how your diabetes management may change. For example, oral diabetes medications may be stopped and replaced with insulin.

Planning for an upcoming pregnancy will include:

• Making sure your blood glucose levels are in an acceptable range
• Maintaining a healthy weight or losing weight before you become pregnant
• Exercising regularly
• Eating a healthful diet that is rich in nutrients

During Pregnancy

Your diabetes treatment plan will need to be adjusted throughout your pregnancy as your baby grows. It is important to work with your healthcare team throughout your pregnancy to help you manage your changing needs. Your team may include your primary care doctor, endocrinologist (diabetes specialist), nurses, an obstetrician who specializes in high-risk pregnancies, a dietitian, and a diabetes educator. The plan will start by setting target blood glucose levels, and hemoglobin A1C level.

The changes pregnancy makes to your body, such as reduced sensitivity to insulin, will affect your blood glucose levels in different ways. Regular monitoring of your blood glucose at home will help you develop the best treatment plan. Some steps that can help with blood glucose control include:

• Keep a record of your blood glucose tests and share with your medical team. If you are experiencing too many low or high levels your team may want to adjust your treatment plan.
• Insulin is safe to use during pregnancy, but other medications may need to be stopped. This may include type 2 diabetes control medications. Talk to your doctor about all of your medications.
• A good diet is important for your pregnancy, diabetes, and weight management. Aim for a diet with:
• • Plenty of fruits and vegetables and whole grains
  • Lean meats, poultry, fish, nuts, and beans
  • Nonfat dairy products

• Monitor your weight. Ask your doctor what weight gain they are expecting.
• Exercise can be good for you and your baby through pregnancy. Talk to your doctor about your activity plans.
• • Exercise after eating can help manage blood glucose levels.
  • Test your blood glucose levels after exercise. If blood glucose levels are too low after exercise talk to your medical team about adjustments to your treatment plan.

Labor and Delivery

Labor and delivery may be a planned cesarean, induced birth, or follow its natural course. In either case, your medical team will monitor your blood glucose level throughout the process. Your treatment plan, including insulin dose, will be tailored as needed.

After the Birth of Your Baby

After your baby is born, your glucose levels may be unpredictable, especially if you are breastfeeding. Track your blood glucose levels often and share this with your medical team.