Diabetes poses special challenges for women who want to become pregnant. Any woman with diabetes who is considering having a baby should therefore first have a thorough physical examination. A preconception exam typically includes a dietary evaluation and a drug, obstetric, gynecological and medical history, as well as laboratory tests, to help identify any risks that may jeopardize the health of the mother or baby. If a patient has diabetic complications such as heart disease or high blood pressure, these conditions should be treated before conception.

Additionally, if a woman is taking certain medications that are not recommended during pregnancy, such as ACE inhibitors or diuretics, the physician may suggest alternatives and discuss any other steps that must be taken before conception.

It is also important for women with diabetes to receive prepregnancy counseling. Preconception information and support should be provided by the woman's physician as well as the following healthcare professionals:

• An obstetrician (a physician who cares for women during and immediately after pregnancy) trained to handle high-risk pregnancies.
  
  
• A neonatologist (a physician who specializes in the treatment of newborns) or pediatrician (a physician who specializes in the treatment of children) experienced in treating babies of diabetic mothers.
  
  
• A registered dietitian who can develop and alter a patient's meal plan as nutritional needs change during and after pregnancy.
  
  
• A diabetes educator to help the patient manage diabetes during pregnancy.

Preconception care, which is designed to minimize birth defects, teaches women about the pregnancy risks to mother and baby. Evidence indicates that enrollment in a preconception diabetes care program may reduce the higher prevalence of birth defects and miscarriages that occur in women with diabetes. Diabetic women should ask their counselor about their preconception glycemic goals (a glycohemoglobin A1C test result of 7 or lower is typical). The counselor will also review the following diabetes self–management skills:

• Meal planning
  
  
• Testing and interpreting glucose (blood sugar) levels before and after meals
  
  
• Adjusting insulin (a hormone that regulates glucose) when necessary

• Treating hypoglycemia (low glucose) if it occurs
  
  
• Making appropriate lifestyle modifications, such as diet and exercise

In addition, the counselor will discuss issues that affect all pregnant women, such as taking supplements of folic acid before conception to reduce neural tube defects (birth defects that affect the brain and spinal cord), and the effects of smoking and alcohol on a fetus. It is often helpful to include the woman's partner in preconception discussions.

The goal for diabetic women who would like to become pregnant is to achieve close-to-normal glucose levels before conception. Glucose irregularities can alter the mother's metabolism and produce changes in the intrauterine environment where the baby grows.

Tight control of glucose is important during all stages of pregnancy. However, uncontrolled glucose is especially dangerous during the first six to eight weeks of pregnancy when the baby's organs are forming the most. Because women do not typically realize that they are pregnant for up to a month after conception, women with diabetes should take extra care to plan their pregnancy, and thus reduce the risk of fetal abnormalities. For this reason the American Diabetes Association (ADA) recommends that women control their glucose levels for three to six months before trying to conceive.

Good prenatal care is especially important in light of recent research findings that babies of low birth weight or high birth weight who later develop diabetes may be more likely to die of diabetic complications.