If you have diabetes — either type 1 or type 2 — and you're thinking about having a baby, you might be concerned about the risks. To put your mind at ease, get serious about preparing for pregnancy. Controlling your blood sugar level and making healthy lifestyle choices before pregnancy can help you give your baby the healthiest start.
Start with a checkup
The first step in preparing for pregnancy is to see your health care provider for a consultation. Mention your interest in pregnancy. If you take oral diabetes medication, you might need to switch to insulin or make other changes to your diabetes treatment plan before you conceive. Other medication changes might be needed as well. For example, some medications — including certain drugs to treat high blood pressure or kidney problems — aren't recommended during pregnancy. If you have high blood pressure or signs of heart, eye, nerve or kidney disease — or other diabetes complications that could be aggravated by pregnancy — preparing for pregnancy might include treatment before conception.
Your health care provider might also suggest scheduling preconception appointments with an obstetrician who specializes in high-risk pregnancies, a diabetes educator, a registered dietitian or other specialists.
Focus on blood sugar control
Controlling your blood sugar level is the best way to prevent diabetes complications. When you're preparing for pregnancy, blood sugar control is more important than ever — even months before you conceive.
Your baby's brain, spinal cord, heart and other organs begin forming soon after conception, even before you know you're pregnant. If you have poor blood sugar control during the earliest days of pregnancy, your risk of miscarriage and your baby's risk of birth defects — particularly those affecting the brain, spinal cord and heart — increase. However, if you manage your blood sugar level before you conceive and throughout pregnancy, your odds of having a healthy baby are nearly the same as if you didn't have diabetes.
Your health care provider will help you establish your target blood sugar range. He or she will also evaluate your diabetes treatment plan and consider any changes that might be needed to improve it. For example, some women preparing for pregnancy might consider using an insulin pump or increasing the number of insulin injections to improve blood sugar control. The goal is to keep your blood sugar level as close to normal as possible.
Remember healthy-eating principles
Your diabetes diet probably includes plenty of fruits, vegetables and whole grains. You can eat the same foods as you're preparing for pregnancy. If you're having trouble keeping your blood sugar level in your target range or you want to lose excess pounds before pregnancy, consult a registered dietitian. He or she can help you customize your diabetes meal plan to meet your pre-pregnancy needs.
To help fill any nutritional gaps, take prenatal vitamins that contain folic acid — ideally starting a few months before conception.
Include physical activity in your daily routine
Physical activity is another important part of your diabetes treatment plan. During your preconception appointment, get your doctor's OK to exercise. Then choose activities you enjoy, such as walking, swimming or stationary biking. What's most important is making physical activity part of your daily routine. Aim for at least 150 minutes a week of moderate aerobic activity — based on Department of Health and Human Services guidelines for exercise during pregnancy. If you haven't been active for a while, start slowly and build up gradually.
Remember that physical activity affects blood sugar. Check your blood sugar level before and after any activity, especially if you take insulin. You might need to eat a snack before exercising to help prevent low blood sugar. If you're using an insulin pump, you might need to adjust the basal rate for exercise.
Know what's off-limits
When you're preparing for pregnancy, don't:
- Skip doses of insulin or other medications
- Drink alcohol
- Use illegal drugs
It's also important to keep stress under control. Too much stress can interfere with your blood sugar level and make it harder to take good care of yourself — and your baby.
Patience pays off
Preparing for pregnancy might take a number of months and multiple visits to your health care provider. In fact, the American Diabetes Association recommends maintaining good blood sugar control for three to six months before attempting to conceive. Your health care provider might want you to reach a specific hemoglobin A1C level — a reflection of your blood sugar level for the past two to three months — before pregnancy.
Until your health care provider gives you the green light for pregnancy, remember to use a reliable method of birth control. A healthier pregnancy is worth the wait.