In decades past, women with diabetes were discouraged from becoming pregnant because they faced increased risk of complications, including miscarriage, stillbirth and birth defects in the baby. There is still an increased risk of complications -- up to 4 times the risk of birth defects, the Centers for Disease Control and Prevention (CDC) reported in 2008 -- but in many cases diabetic women can have successful pregnancies and healthy babies.

Some women with diabetes may still be advised by their physician to avoid pregnancy for their own safety. A diabetic woman's pregnancy is automatically considered high risk, but those who control their glucose (blood sugar) before and during pregnancy are almost as likely to have a healthy baby as those without diabetes, according to the National Institutes of Health (NIH). This applies to women with type 1 diabetes, type 2 diabetes and lesser-known forms of diabetes such as latent autoimmune diabetes of adulthood (LADA) and maturity-onset diabetes of the young (MODY).

Data indicate that diabetes in the mother complicates 2 to 3 percent of all pregnancies but may underestimate the prevalence, according to NIH. Some recent studies suggest that diabetic complications during pregnancy are a growing problem because increasing rates of obesity are causing diabetes to develop more often and at an earlier age. Type 2 diabetes, by far the most common form of diabetes, was once rare during the childbearing years but has become more common in young adulthood. The number of pregnant women who have type 1 or type 2 diabetes has doubled since 1999, according to research in 2008.

Sometimes nondiabetic women develop a temporary form of diabetes during pregnancy. This is called gestational diabetes. Typically it develops late in the pregnancy and has fewer risks than other forms of diabetes. Risk factors for gestational diabetes include:

• Being over age 25
• Having a family history of diabetes
• Being overweight
• Being a member of an ethnic or racial group with a high occurrence of diabetes (e.g., black American, Hispanic, Asian and Native American)

Women at increased risk for gestational diabetes should be tested for the condition, typically between their 24th and 28th week of pregnancy.

In any type of diabetes, strict management of glucose levels is essential prior to conception and during all stages of pregnancy. This is because glucose fluctuations throughout a pregnancy can cause complications for the expectant mother and the fetus. Uncontrolled glucose is especially dangerous during the first six to eight weeks of pregnancy when the baby’s organs are forming.

Expectant mothers with diabetes have to visit their physician more frequently than women without diabetes. Women with mild diabetes or exceptional glucose control can often carry their baby to term without any issues. However, many healthcare providers prefer to schedule an early delivery of babies with diabetic mothers, typically around 38 to 39 weeks.

Because of the level of care required for the mother and baby during and after delivery, home births are not generally recommended for women with diabetes. As long as glucose levels are normal, there are no prior complications and the baby is not oversized (a condition called macrosomia), a woman with diabetes can usually deliver vaginally. If complications occur, however, a Caesarean section (C–section) may become necessary. Regardless of which delivery method is used, glucose is carefully monitored during labor, and most diabetic women who maintain good glucose control during pregnancy have a healthy baby.

For any parent, having a baby is a considerable financial investment. However, women with diabetes and their partners should be prepared to pay additional expenses associated with good glucose control, even if they have medical insurance coverage. These expenses may include:

• More frequent visits to the physician.
  
  
• Nutritional counseling.
  
  
• Extra glucose test strips. Some pregnant women with diabetes must perform glucose monitoring seven or more times a day.
  
  
• Extra ketone strips. Pregnant women with diabetes may be advised by their physician to monitor ketones (a waste product found in urine) frequently.
  
  
• Insulin (a hormone that regulates glucose). Women with type 2 diabetes who take oral diabetes medication (antidiabetic agents) are usually switched to insulin injections by their physician to help ensure the safety of the fetus. There are costs associated with taking insulin, such as syringes and training.

  

• Additional medical and laboratory tests. Depending on the physician and the patient’s risk factors, women with diabetes may be more likely to undergo additional ultrasounds or procedures such as amniocentesis. In amniocentesis, a needle is inserted through the woman’s abdomen to draw a fluid sample from the amniotic sac surrounding the fetus.