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Pregnancy and diabetes

Plan your pregnancy to avoid complications. Working with your diabetes
care team to plan your pregnancy can prevent diabetic complications for
you and your baby.

Women with diabetes who control their blood sugar before they're pregnant and during their pregnancy have almost the same chance of having a healthy baby as women without diabetes.

Why it's best to plan your pregnancy

To prevent diabetes-related complications for both you and your baby, make sure your blood sugar is under control before you become pregnant. Your blood sugar not only affects your health, it affects your baby's health, too.

Your baby's organs form during the first six to eight weeks of pregnancy. But you probably won't know you're pregnant until your baby has been growing for two to four weeks. So if you don't plan your pregnancy and you have poor blood sugar control, your baby's risk of birth defects is much higher. Birth defects can affect your baby's brain, heart and kidneys.

To help prevent birth defects, your doctor will recommend that you take a multivitamin with folic acid each day, ideally starting three months before you get pregnant, and a prenatal vitamin throughout your pregnancy.

What to expect

Your doctor and your health care team can help you achieve good blood sugar control and prepare your body for a healthy pregnancy. But it's up to you to follow through with the plan. Here's what your pre-conception plan may include:

-Birth control. Practicing birth control before pregnancy allows you and your health care team to choose the safest time to have a baby.

-Complete physical examination. A physical examination helps identify health conditions that may increase your risk of complications. These conditions include high blood pressure and eye, nerve or kidney disease. Because pregnancy may aggravate these conditions, your doctor will want to treat them before you become pregnant.

-Control over your blood sugar. Good blood sugar control is essential if you're planning to get pregnant. It's one of the most important things you can do to reduce your risk of diabetes-related complications for you and your baby.

If you have type 1 diabetes, you may require intensive insulin therapy, a more complex insulin regimen. The purpose of intensive insulin therapy is to keep your blood sugar within a normal or near-normal range (tight control). This includes frequent monitoring of your blood sugar, a combination of different types of insulin, and adjusting your doses based on your blood sugar levels, diet and changes in your routine. If you have type 2 diabetes, you may have to switch to intensive insulin therapy to get tighter control of your blood sugar.

Your doctor will tell you the target range for your blood sugar as you prepare for pregnancy. When you're pregnant, sample target ranges are 60 to 95 milligrams per deciliter (mg/dL) of blood before meals and less than 120 mg/dL two hours after meals.

When your glycated hemoglobin (hemoglobin A1C) test reaches near-normal levels, less than 7 percent, your doctor may recommend that you discontinue birth control. This test is an overall measurement of your recent blood sugar levels.

-Meal planning. A healthy meal plan helps you maintain normal or near-normal blood sugar levels. You may need to work with a dietitian to modify your meal plan if you're having trouble keeping your blood sugar within its target range or if you need to manage your weight. Artificial sweeteners may be a concern. The effects on the fetus are unknown, so it's best during your pregnancy to avoid products containing saccharin and aspartame.

-Regular exercise. People with diabetes who exercise experience important benefits, such as improved blood sugar control and weight management. This includes women with diabetes who are planning to get pregnant. But start slowly and progress gradually if you haven't been exercising. If you take insulin, don't forget to test your blood sugar before and after you exercise, to avoid low blood sugar.

The American Diabetes Association recommends that your blood sugar level be in good control for three to six months before you try to get pregnant. Even though three to six months can seem like a long time, the rewards are priceless ? a healthier pregnancy for you and your baby.
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