You can have a healthy pregnancy if your blood sugar is in a target range before you get pregnant and you don’t have high blood pressure or problems from diabetes, such as kidney disease. Keeping your blood sugar at a target level lowers your risk of birth defects, miscarriage, and other problems. (The American Diabetes Association suggests an A1c of less than 7% for most nonpregnant adults.^{footnote 1})

The American Diabetes Association (ADA) suggests the following ranges for women with type 1 or type 2 diabetes who become pregnant:^{footnote 1}

• A1c: 6% to 6.5%
• Before meals: 95 mg/dL or lower
• 1 to 2 hours after meals: 120 to 140 mg/dL or lower

Experts recommend keeping blood sugar levels in the target range for 3 to 6 months before you get pregnant. To do this, get plenty of exercise, eat healthy foods, lose weight if you need to, and take medicine if your doctor prescribes it.

Medicines

It’s important to let your doctor know if you are thinking about getting pregnant. If you take pills to treat your diabetes, your doctor may want you to switch to insulin or to a new pill before you get pregnant. And if you take insulin, your doctor may need to change the dose or how you take it, such as through an insulin pump or as shots.

You also need to let your doctor know about any medicine you take to treat other health problems. He or she may have you stop or change your medicine before you get pregnant if you are taking any medicines that could harm your baby.

Screening

When you have diabetes, you need to see your doctor regularly to check for problems from the disease. It’s especially important to do this before you get pregnant. Screening tests help your doctor look for these problems before any symptoms appear. This can increase your chance of finding the problem at a more treatable stage. These tests include:

• An eye exam to look for signs of retinopathy.
• Blood and urine tests to look for kidney damage.
• Blood pressure checks. High blood pressure can cause problems with the mother and the baby. When blood pressure is very high, the placenta may not work well and the doctor may need to deliver the baby early.
• Blood sugar level tests. Your doctor will talk to you about keeping your blood sugar in a target range at all times before and during your pregnancy.

Uncontrolled diabetes increases the risk of problems for both the baby and the mother.

Risks for the baby include:

• Birth defects.
• Early (premature) birth.
• Jaundice.
• Low blood sugar after birth.
• Larger-than-normal size at birth, which can cause shoulder and other problems in the infant.
• Smaller-than-normal size at birth caused by high blood pressure, kidney disease, or problems with the placenta.
• Death, although this is not common now that more women use insulin to control their blood sugar.

Risks for the mother include:

• Miscarriage.
• Kidney damage if creatinine levels are above 2.0 mg/dL.
• High blood pressure during pregnancy (preeclampsia).
• Eye problems during pregnancy that may get better after the baby is born.
• Cesarean section because of a larger-than-normal baby.

Your doctor may advise you NOT to get pregnant now if:

• Your blood sugar is not in your target range.
• You have problems (complications) from diabetes. Being pregnant may make these problems worse.
• You are taking medicines that aren’t safe to use when you are trying to get pregnant.
• You have been pregnant before, and you and your baby had problems related to your diabetes.