If you have type 1 diabetes and you’re thinking about having a baby, planning before you become pregnant is important. Learn how you can stay healthy and help prevent health problems for you and your baby before, during, and after pregnancy.

Deciding to start a family is an exciting time! It can also be overwhelming. It’s natural to have questions about how to keep yourself and your baby healthy during pregnancy, especially if you have type 1 diabetes.

Women with type 1 diabetes can have a healthy pregnancy. Having a plan to manage your diabetes before, during, and after your pregnancy will help keep you and your baby healthy.

Diabetes mellitus type 1 (DM1) is a condition in which cells in the pancreas (beta cells) stop producing insulin, causing abnormally high blood sugar levels. Lack of insulin results in the inability of the body to use glucose for energy and control the amount of sugar in the blood. DM1 can occur at any age, but usually develops by early adulthood, most often in adolescence. Symptoms of high blood sugar may include frequent urination, excessive thirst, fatigue, blurred vision, tingling or loss of feeling in the hands and feet, and weight loss.

The exact cause of DM1 is unknown, but having certain "variants" of specific genes may increase a person's risk to develop the condition. A predisposition to develop DM1 runs in families, but no known inheritance pattern exists.

Treatment includes blood sugar control and insulin replacement therapy. Improper control can cause recurrence of high blood sugar, or abnormally low blood sugar (hypoglycemia) during exercise or when eating is delayed. If not treated, the condition can be life-threatening. Over many years, chronic high blood sugar may be associated with a variety of complications that affect many parts of the body.

Yes. If you have type 1 or type 2 diabetes, you can have a healthy pregnancy. If you have diabetes and you want to have a baby, you need to plan ahead, before you get pregnant.

Talk to your doctor before you get pregnant. He or she can talk to you about steps you can take to keep your baby healthy. This may include a diabetes education program to help you better understand your diabetes and how to control it during pregnancy.

Yes, women with diabetes can and do get pregnant. Pregnant women with diabetes are considered to have a High-Risk Pregnancy because the diabetes increases the risk for some complications. However, most women with diabetes have healthy pregnancies and healthy babies because they follow a health care provider’s recommendations for diabetes management.

If you have diabetes and are thinking about getting pregnant, discuss the subject with your health care provider. You might also want to consult a specialist with expertise dealing with both pregnancy and women with diabetes, as well as experts who can help you make healthy nutritional choices, such as a registered dietitian with a background in diabetes, or a diabetes educator.

Use this planning checklist to learn how you can boost your health and get ready for pregnancy. Being in good overall health before you become pregnant is important.

Manage your blood sugar. Many doctors will recommend that you reach and keep your A1C goal for a few months before becoming pregnant.

Review your medicines. Some medicines and supplements aren’t safe to use while pregnant. You should speak with your health care team about each medicine and supplement you take before you get pregnant. Don’t stop taking prescribed medicines without talking to your doctor first.

As soon as you find out that you’re pregnant, work with your medical team to manage your blood sugar and head off complications.

During your pregnancy, you and your doctors will adjust your diabetes management plan, so it’s important that you trust your team and feel free to reach out to them. If you don’t have these health care specialists as part of your diabetes care team already, consider looking for:

• An endocrinologist (a doctor who treats hormone conditions, including diabetes). You may want to find one who specializes in caring for pregnant women with diabetes.
• An obstetrician (a doctor who treats pregnant women). Your pregnancy may be considered high risk because of your diabetes. If that’s the case, you may want to find an obstetrician who takes care of women with high-risk pregnancies.
• A diabetes educator who can help you manage your diabetes during pregnancy.

Here are a few things to keep in mind:

Keep your A1C levels on target. Blood sugar levels that stay high during pregnancy may cause your baby to grow too large (macrosomia) or harm the early development of organs and lead to birth defects.

Know your risks. Women who have type 1 diabetes can have a safe pregnancy and a healthy baby, but it’s important to monitor diabetes complications that could worsen throughout pregnancy, such as high blood pressure, vision loss, and kidney disease. Other risks include:

• Preecalampsia – high blood pressure that can damage the liver and kidneys.
• Insulin resistance – when insulin is less effective at lowering your blood sugar.
• Miscarriage.
• Macrosomia – a larger-than-average baby. This can lead to a more difficult delivery.
• Birth defects that may affect your baby’s heart, brain, spine, kidneys, digestive system, limbs, and mouth.

Be aware of changing insulin needs. Your insulin needs may change throughout your pregnancy. Low blood sugar is common in women with type 1 diabetes. Check with your health care team about how much insulin you need and how often you need it.

Consider using a continuous glucose monitor (CGM). A CGM will help you notice your blood sugar patterns, which can help you stay in your target range. Talk to your doctor to see if a CGM is right for you.

Create a birth plan. You may want to consider:

• If you are delivering in a hospital, what is the procedure for women who wear an insulin pump?
• Can you keep your CGM on during labor and delivery?
• Who will manage your blood sugar levels during and after labor and delivery?
• What diabetes supplies do you need to pack in your hospital bag?

Monitoring blood sugar and insulin. Your blood sugar levels may rise during labor, but they may drop just before you give birth or immediately after—regardless of whether you have a vaginal delivery or a Cesarean (C-section). Your doctor can help you plan for the insulin dose changes and monitoring throughout your delivery and after. You may wear your insulin pump or CGM during delivery.

Breastfeeding. Breastfeeding offers many health benefits to both the mother and baby. For the mother, it can help you lose extra weight you may have gained during pregnancy, and it can reduce the risk of high blood pressure, ovarian cancer, and breast cancer. Breastfeeding gives the baby the best nutrition to stay healthy, while reducing the risk of asthma, obesity, and severe lung disease. Women with type 1 diabetes can breastfeed their babies. Having diabetes may delay your ability to produce breast milk at first, but it should improve over time. Breastfeeding is an energy-consuming activity, just like physical activity. This can cause low blood sugar, so you should let those who will be around you know the signs of low blood sugar and how to treat it.

Careful planning and attention to your medical needs give you the best chance to stay healthy during pregnancy and have a healthy baby. You can do it!

Most women who have diabetes and become pregnant or who have gestational diabetes have healthy pregnancies and deliver healthy babies because they manage their diabetes.

However, diabetes and especially uncontrolled diabetes are associated with several complications, including (but not limited to):

• Jaundice (pronounced JAWN-diss)—This yellowish tint to the infant’s skin is treatable and typically has no lasting effects.
• Hypoglycemia (pronounced hahy-poh-glahy-SEE-mee-uh)—Infant’s blood sugar is too low. You many need to breastfeed quickly, or find other ways to get more sugar into his/her system.
• Macrosomia (pronounced mak-row-SOHM-ee-uh)—Infant is large, which increases the likelihood of a cesarean or surgical delivery.
• Respiratory distress syndrome—Infant has trouble breathing and may require oxygen or other treatments.
• Low calcium and magnesium levels—Infant may need supplements to avoid other complications.

Working with your health care provider to control diabetes can help reduce the risk of these and other complications.

In addition, children whose mothers had gestational diabetes are at higher lifetime risk for type 2 diabetes, and for having it at a younger age than children whose mothers didn’t have the condition.

Blood sugar that is not well controlled in a pregnant woman with Type 1 or Type 2 diabetes could lead to problems for the woman and the baby:

Birth Defects

The organs of the baby form during the first two months of pregnancy, often before a woman knows that she is pregnant. Blood sugar that is not in control can affect those organs while they are being formed and cause serious birth defects in the developing baby, such as those of the brain, spine, and heart.

An Extra Large Baby

Diabetes that is not well controlled causes the baby’s blood sugar to be high. The baby is “overfed” and grows extra large. Besides causing discomfort to the woman during the last few months of pregnancy, an extra large baby can lead to problems during delivery for both the mother and the baby. The mother might need a C-Section to deliver the baby. The baby can be born with nerve damage due to pressure on the shoulder during delivery.

C- Section (Cesarean Section)

A C-section is a surgery to deliver the baby through the mother’s belly. A woman who has diabetes that is not well controlled has a higher chance of needing a C-section to deliver the baby. When the baby is delivered by a C-section, it takes longer for the woman to recover from childbirth.

High Blood Pressure (Preeclampsia)

When a pregnant woman has high blood pressure, protein in her urine, and often swelling in fingers and toes that doesn’t go away, she might have preeclampsia. It is a serious problem that needs to be watched closely and managed by her doctor. High blood pressure can cause harm to both the woman and her unborn baby. It might lead to the baby being born early and also could cause seizures or a stroke (a blood clot or a bleed in the brain that can lead to brain damage) in the woman during labor and delivery. Women with type 1 or type 2 diabetes have high blood pressure more often than women without diabetes.

Early (Preterm) Birth

Being born too early can result in problems for the baby, such as breathing problems, heart problems, bleeding into the brain, intestinal problems, and vision problems. Women with type 1 or type 2 diabetes are more likely to deliver early than women without diabetes.

Low Blood Sugar (Hypoglycemia)

People with diabetes who take insulin or other diabetes medications can develop blood sugar that is too low. Low blood sugar can be very serious, and even fatal, if not treated quickly. Seriously low blood sugar can be avoided if women watch their blood sugar closely and treat low blood sugar early.

If a woman’s diabetes was not well controlled during pregnancy, her baby can very quickly develop low blood sugar after birth. The baby’s blood sugar must be watched for several hours after delivery.

Miscarriage or Stillbirth

A miscarriage is a loss of the pregnancy before 20 weeks. Stillbirth means that after 20 weeks, the baby dies in the womb. Miscarriages and stillbirths can happen for many reasons. A woman who has diabetes that is not well controlled has a higher chance of having a miscarriage or stillbirth.

If a woman with diabetes keeps her blood sugar well controlled before and during pregnancy, she can increase her chances of having a healthy baby. Controlling blood sugar also reduces the chance that a woman will develop common problems of diabetes, or that the problems will get worse during pregnancy.

Steps women can take before and during pregnancy to help prevent problems:

1. Plan for Pregnancy
   Before getting pregnant, see your doctor. The doctor needs to look at the effects that diabetes has had on your body already, talk with you about getting and keeping control of your blood sugar, change medications if needed, and plan for frequent follow-up. If you are overweight, the doctor might recommend that you try to lose weight before getting pregnant as part of the plan to get your blood sugar in control.
2. See Your Doctor Early and Often
   During pregnancy, a woman with diabetes needs to see the doctor more often than a pregnant woman without diabetes. Together, you and your doctor can work to prevent or catch problems early.
3. Eat Healthy Foods
   Eat healthy foods from a meal plan made for a person with diabetes. A dietitian can help you create a healthy meal plan. A dietitian can also help you learn how to control your blood sugar while you are pregnant.
4. Exercise Regularly
   Exercise is another way to keep blood sugar under control. It helps to balance food intake. After checking with your doctor, you can exercise regularly before, during, and after pregnancy. Get at least 30 minutes of moderate-intensity physical activity at least five days a week. This could be brisk walking, swimming, or actively playing with children.
5. Take Pills and Insulin as Directed
   If diabetes pills or insulin are ordered by your doctor, take them as directed in order to help keep your blood sugar under control.
6. Control and Treat Low Blood Sugar Quickly
   Keeping blood sugar well controlled can lead to a chance of low blood sugar at times. If you are taking diabetes pills or insulin, it’s helpful to have a source of quick sugar, such as hard candy, glucose tablets or gel, on hand at all times. It’s also good to teach family members and close co-workers or friends how to help in case of a severe low blood sugar reaction.
7. Monitor Blood Sugar Often
   Because pregnancy causes the body’s need for energy to change, blood sugar levels can change very quickly. You need to check your blood sugar often, as directed by your doctor. It is important to learn how to adjust food intake, exercise, and insulin, depending on the results of your blood sugar tests.