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Preconception planning for the woman with diabetes               Is your body ready? | Aim for near-normal glucose levels

Planning to get pregnant?  Read this FIRST

Women with diabetes who are considering pregnancy are strongly urged to achieve excellent blood glucose control before conception. That's because hyperglycemia can increase the risk of a miscarriage or of birth defects in the baby. When women have maintained strict blood glucose control prior to conceiving and during the first trimester, the incidence of malformations is much lower than in women with diabetes who did not.

If you are planning to start your family, it is critically important that you discuss your decision with your healthcare provider and members of your diabetes care team right away. You will also want to choose an obstetrician who is familiar with the special challenges of a diabetic pregnancy. 

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Is your body ready?

• Diabetic retinopathy may develop or worsen during pregnancy. You should have a dilated eye exam before you become pregnant, and plan on follow-up exams with an ophthalmologist during the course of your pregnancy.

• Hypertension frequently accompanies diabetes; women who are contemplating pregnancy or are pregnant should not take ACE inhibitors, beta-blockers, or diuretics as anti-hypertensive drugs.
  Related information Hypertension and Pregnancy

• Kidney disease may be worsened by pregnancy, so your doctor will order lab tests to check on your kidney functioning. This is important both for you and also for the baby, since kidney insufficiency can negatively impact the baby's growth and development. Any worsening of kidney disease that occurs during pregnancy is transient in many women with mild kidney disease. In more severe cases, the worsening is more likely to be permanent.

• Autonomic neuropathy, or nerve damage to the internal organs, can complicate the management of diabetes in pregnancy. This is sometimes manifested by gastroparesis, which disrupts the digestion of food and requires careful treatment before pregnancy. It may also cause urinary retention or orthostatic hypotension (a sudden drop in blood pressure that occurs when you rise quickly from a sitting or lying position).

• Peripheral neuropathy is nerve damage, including disorders such as carpal tunnel syndrome, and may be worsened in women who are pregnant.

• Cardiovascular disease can be dangerous during pregnancy if untreated. Your doctor will want to see your exercise tolerance in the normal range to maximize the probability that your heart can tolerate the increased demands of pregnancy. Women who have had angioplasty or other coronary revascularization procedures have had successful pregnancies.

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Aim for near-normal glucose levels

The most essential thing you must do is to get your blood glucose levels as close to normal as possible -- ideally for three months before you become pregnant. Even more important is to maintain them at that level for at least the critical first three months of pregnancy. That is when the baby is developing rapidly and the time during which congenital malformations can occur if glucose levels are high.

Studies have shown that when the HbA1c level is within 1% of normal, the rates of congenital deformities and spontaneous abortion are no different from those in women without diabetes. Above that, however, the incidence rises.

You'll need to monitor your glucose levels frequently - it is not unusual for pregnant women to perform self-monitoring of blood glucose (SMBG) 6 to 8 times a day. The ADA recommends these goals for blood glucose control during pregnancy:

Goals for self-monitored glucose