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Diabetes: Should I Get Pregnant


What is a Decision Point?

Decision Point

Diabetes: Should I Get Pregnant?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Diabetes: Should I Get Pregnant?

Get the facts

Your options

  • Try to get pregnant now.
  • Don't try to get pregnant now.

Key points to remember

  • Is your blood sugar in a target range for pregnancy? Women with diabetes who want to get pregnant should have blood sugar levels in a target range before they get pregnant. (The American Diabetes Association suggests an A1c of less than 6.0%.)1 This lowers the chance of birth defects, miscarriage, and other problems. Check your blood sugar throughout the day to see if it is in a target range. If not, consider using birth control until your blood sugar is in that range.
  • Do you take pills to treat diabetes? Your doctor may have you switch to insulin or take a different pill before you get pregnant. If you are changing to insulin or a new pill, make sure that the medicine is controlling your blood sugar before you try to get pregnant.
  • Do you take insulin? Talk to your doctor before you try to get pregnant to see if you need to change your dose or how you take it (such as through an insulin pump or as shots). If you figure out the right dose of insulin to take before you get pregnant, you are less likely to have problems with high and low blood sugar during your pregnancy.
  • Do you take medicine to treat other problems? Talk to your doctor before you get pregnant to see if you need to stop or change your medicine.
  • Do you have problems from diabetes, such as eye or kidney disease? If you do, being pregnant can make some of these problems worse. Also, high blood pressure can create problems for you and affect your baby's growth during pregnancy.
  • Do you have other children? If so, how did the diabetes affect your pregnancy?
  • Do you take a folic acid supplement? Taking a daily multivitamin or prenatal vitamin with folic acid reduces the chance of having a baby with a birth defect.
FAQs

What should you do before you get pregnant when you have diabetes?

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 (ADA) suggests the following ranges for women with type 1 or type 2 diabetes who become pregnant:1

  • A1c: Less than 6.0%
  • Before meals, bedtime, and overnight: 60 to 99 mg/dL
  • 1 to 2 hours after meals: 100 to 129 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.

What should you talk to your doctor about?

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.
  • Thyroid-stimulating hormone (TSH) test. This test is used to check for thyroid gland problems such as hypothyroidism, which can harm your baby if not treated.

What are the risks from getting pregnant when your diabetes is not controlled?

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.

Why might your doctor recommend that you NOT get pregnant now?

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

  • Your blood sugar is not in a normal or near-normal 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.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Choose to get pregnant now Choose to get pregnant now
  • You keep your blood sugar in a near-normal range for at least 3 months before you try to get pregnant.
  • You talk to your doctor about what medicines are safe to use when you are trying to get pregnant.
  • You check with your doctor to make sure that you don't have any problems from diabetes.
  • You keep your diabetes under control, and you increase your chances of having a healthy 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 in the baby after birth.
    • Larger-than-normal size at birth.
    • Smaller-than-normal size at birth.
    • Death, although this is not common.
  • Risks for the mother include:
    • Miscarriage.
    • Kidney damage.
    • High blood pressure during pregnancy (preeclampsia).
    • Eye problems during pregnancy.
    • Cesarean section because of a larger-than-normal baby.
Choose not to get pregnant now Choose not to get pregnant now
  • You talk with your doctor about your desire to have a baby. Working closely with your doctor, you may be able to set a goal for managing your diabetes so that you can get pregnant later.
  • You avoid the risks of being pregnant while your diabetes is not controlled.
  • It may be disappointing to not be able to have a baby when you want to.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about deciding about getting pregnant when you have diabetes

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I have had diabetes for a long time. So when my husband and I started talking about having a baby, I mentioned it to my doctor during my regular checkup. I do a good job of keeping my blood sugar under control. So after doing some tests and adjusting my medicine, my doctor said it was safe to start trying. I got pregnant and gave birth to a healthy baby boy.

Mandy, age 32

My life has been pretty stressful, and it has been hard to keep my blood sugar in a normal range. I want to get pregnant before I'm too old, but I worry about the risk of birth defects if I get pregnant now. Having a baby is a priority for me, so I talked to my doctor about some specific changes I can make to lower my stress level and focus on my health. I am going to wait for now to see if I can get my blood sugar under control.

Rachael, age 38

I have two children, and we want to try for a third. I had diabetes with both my pregnancies. My doctor worked with me to set target blood sugar levels before each pregnancy, and everything went smoothly. I am now 5 months pregnant and feeling good.

Janelle, age 34

Recently I was diagnosed with type 2 diabetes. I am newly married, and my husband and I want to have a family in the next few years. I am taking medicine and trying to eat right and get exercise so that I will be healthy when we decide that the time is right to start trying to have a baby.

Christine, age 26

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to try to get pregnant now

Reasons not to try to get pregnant now

I am not worried that my diabetes will cause health problems for my baby.

I am worried that my diabetes may cause health problems for my baby.

More important
Equally important
More important

I want to try to get pregnant now. I don't want to wait.

I want to wait until my doctor says it is safe before I try to get pregnant.

More important
Equally important
More important

My blood sugar levels are under control, and I'm confident that I can keep them controlled.

I want to get my blood sugar levels under control before I try to get pregnant.

More important
Equally important
More important

I'm not worried that getting pregnant now could harm my health.

I am worried that getting pregnant now could harm my health.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Trying to get pregnant now

NOT trying to get pregnant now

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

As long as my doctor says my medicine is controlling my diabetes, it is safe for me to try to get pregnant.

  • TrueNo, that's not right. Having your diabetes under control isn't enough. To have a healthy pregnancy, you also need to make sure that you don't have high blood pressure or problems from diabetes, such as kidney disease.
  • FalseYou're right. Having your diabetes under control isn't enough. To have a healthy pregnancy, you also need to make sure that you don't have high blood pressure or problems from diabetes, such as kidney disease.
  • I'm not sureIt may help to go back and read "Get the Facts." To have a healthy pregnancy, you also need to make sure that you don't have high blood pressure or other problems.
2.

My blood sugar levels should be in a target range for at least 3 months before I get pregnant.

  • TrueThat's right. You should have blood sugar levels in a target range for at least 3 months before you get pregnant. This lowers the chance of birth defects, miscarriage, and other problems.
  • FalseNo, that's not right. You should have blood sugar levels in a target range for at least 3 months before you get pregnant. This lowers the chance of birth defects, miscarriage, and other problems.
  • I'm not sureIt may help to go back and read "Get the Facts." You should have your blood sugar levels in a target range for at least 3 months before you get pregnant.
3.

Before I get pregnant, I need to see my doctor regularly to check for diabetes complications, such as eye or kidney disease.

  • TrueThat's right. When you have diabetes, you need to see your doctor regularly to check for complications from the disease. These problems can get worse during pregnancy.
  • FalseThat's not right. When you have diabetes, you need to see your doctor regularly to check for complications from the disease. These problems can get worse during pregnancy.
  • I'm not sureIt may help to go back and read "Get the Facts." When you have diabetes, you need to see your doctor regularly to check for complications from the disease. Pregnancy can make these problems worse.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient choices

Credits and References

Credits
CreditsHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerJennifer Hone, MD - Endocrinology, Diabetes and Metabolism

References
Citations
  1. American Diabetes Association (2012). Standards of medical care in diabetes—2012. Diabetes Care, 35(Suppl 1): S11–S63.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Diabetes: Should I Get Pregnant?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the facts

Your options

  • Try to get pregnant now.
  • Don't try to get pregnant now.

Key points to remember

  • Is your blood sugar in a target range for pregnancy? Women with diabetes who want to get pregnant should have blood sugar levels in a target range before they get pregnant. (The American Diabetes Association suggests an A1c of less than 6.0%.)1 This lowers the chance of birth defects, miscarriage, and other problems. Check your blood sugar throughout the day to see if it is in a target range. If not, consider using birth control until your blood sugar is in that range.
  • Do you take pills to treat diabetes? Your doctor may have you switch to insulin or take a different pill before you get pregnant. If you are changing to insulin or a new pill, make sure that the medicine is controlling your blood sugar before you try to get pregnant.
  • Do you take insulin? Talk to your doctor before you try to get pregnant to see if you need to change your dose or how you take it (such as through an insulin pump or as shots). If you figure out the right dose of insulin to take before you get pregnant, you are less likely to have problems with high and low blood sugar during your pregnancy.
  • Do you take medicine to treat other problems? Talk to your doctor before you get pregnant to see if you need to stop or change your medicine.
  • Do you have problems from diabetes, such as eye or kidney disease? If you do, being pregnant can make some of these problems worse. Also, high blood pressure can create problems for you and affect your baby's growth during pregnancy.
  • Do you have other children? If so, how did the diabetes affect your pregnancy?
  • Do you take a folic acid supplement? Taking a daily multivitamin or prenatal vitamin with folic acid reduces the chance of having a baby with a birth defect.
FAQs

What should you do before you get pregnant when you have diabetes?

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 (ADA) suggests the following ranges for women with type 1 or type 2 diabetes who become pregnant:1

  • A1c: Less than 6.0%
  • Before meals, bedtime, and overnight: 60 to 99 mg/dL
  • 1 to 2 hours after meals: 100 to 129 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.

What should you talk to your doctor about?

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.
  • Thyroid-stimulating hormone (TSH) test. This test is used to check for thyroid gland problems such as hypothyroidism, which can harm your baby if not treated.

What are the risks from getting pregnant when your diabetes is not controlled?

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.

Why might your doctor recommend that you NOT get pregnant now?

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

  • Your blood sugar is not in a normal or near-normal 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.

2. Compare your options

Choose to get pregnant now Choose not to get pregnant now
What is usually involved?
  • You keep your blood sugar in a near-normal range for at least 3 months before you try to get pregnant.
  • You talk to your doctor about what medicines are safe to use when you are trying to get pregnant.
  • You check with your doctor to make sure that you don't have any problems from diabetes.
  • You talk with your doctor about your desire to have a baby. Working closely with your doctor, you may be able to set a goal for managing your diabetes so that you can get pregnant later.
What are the benefits?
  • You keep your diabetes under control, and you increase your chances of having a healthy pregnancy.
  • You avoid the risks of being pregnant while your diabetes is not controlled.
What are the risks and side effects?
  • 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 in the baby after birth.
    • Larger-than-normal size at birth.
    • Smaller-than-normal size at birth.
    • Death, although this is not common.
  • Risks for the mother include:
    • Miscarriage.
    • Kidney damage.
    • High blood pressure during pregnancy (preeclampsia).
    • Eye problems during pregnancy.
    • Cesarean section because of a larger-than-normal baby.
  • It may be disappointing to not be able to have a baby when you want to.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about deciding about getting pregnant when you have diabetes

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I have had diabetes for a long time. So when my husband and I started talking about having a baby, I mentioned it to my doctor during my regular checkup. I do a good job of keeping my blood sugar under control. So after doing some tests and adjusting my medicine, my doctor said it was safe to start trying. I got pregnant and gave birth to a healthy baby boy."

— Mandy, age 32

"My life has been pretty stressful, and it has been hard to keep my blood sugar in a normal range. I want to get pregnant before I'm too old, but I worry about the risk of birth defects if I get pregnant now. Having a baby is a priority for me, so I talked to my doctor about some specific changes I can make to lower my stress level and focus on my health. I am going to wait for now to see if I can get my blood sugar under control."

— Rachael, age 38

"I have two children, and we want to try for a third. I had diabetes with both my pregnancies. My doctor worked with me to set target blood sugar levels before each pregnancy, and everything went smoothly. I am now 5 months pregnant and feeling good."

— Janelle, age 34

"Recently I was diagnosed with type 2 diabetes. I am newly married, and my husband and I want to have a family in the next few years. I am taking medicine and trying to eat right and get exercise so that I will be healthy when we decide that the time is right to start trying to have a baby."

— Christine, age 26

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to try to get pregnant now

Reasons not to try to get pregnant now

I am not worried that my diabetes will cause health problems for my baby.

I am worried that my diabetes may cause health problems for my baby.

More important
Equally important
More important

I want to try to get pregnant now. I don't want to wait.

I want to wait until my doctor says it is safe before I try to get pregnant.

More important
Equally important
More important

My blood sugar levels are under control, and I'm confident that I can keep them controlled.

I want to get my blood sugar levels under control before I try to get pregnant.

More important
Equally important
More important

I'm not worried that getting pregnant now could harm my health.

I am worried that getting pregnant now could harm my health.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Trying to get pregnant now

NOT trying to get pregnant now

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. As long as my doctor says my medicine is controlling my diabetes, it is safe for me to try to get pregnant.

  • True
  • False
  • I'm not sure
You're right. Having your diabetes under control isn't enough. To have a healthy pregnancy, you also need to make sure that you don't have high blood pressure or problems from diabetes, such as kidney disease.

2. My blood sugar levels should be in a target range for at least 3 months before I get pregnant.

  • True
  • False
  • I'm not sure
That's right. You should have blood sugar levels in a target range for at least 3 months before you get pregnant. This lowers the chance of birth defects, miscarriage, and other problems.

3. Before I get pregnant, I need to see my doctor regularly to check for diabetes complications, such as eye or kidney disease.

  • True
  • False
  • I'm not sure
That's right. When you have diabetes, you need to see your doctor regularly to check for complications from the disease. These problems can get worse during pregnancy.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

Credits
ByHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerJennifer Hone, MD - Endocrinology, Diabetes and Metabolism

References
Citations
  1. American Diabetes Association (2012). Standards of medical care in diabetes—2012. Diabetes Care, 35(Suppl 1): S11–S63.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Last Revised: June 29, 2011

Author: Healthwise Staff

Medical Review: E. Gregory Thompson, MD - Internal Medicine & Jennifer Hone, MD - Endocrinology, Diabetes and Metabolism


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