Although pregnancy is no longer discouraged among most diabetic women as it once was, pregnant women with diabetes should be aware of the risks to the fetus and child. For instance, some evidence suggests that offspring of mothers who did not exercise tight control of glucose (blood sugar) during pregnancy have an increased risk of speech difficulties, poor eye-movement coordination, socialization problems, chromosomal defects and eating disorders. Other risks that may be associated with maternal diabetes include:

• Miscarriage. Women with diabetes have a greater risk of miscarriage than women without diabetes. However, this risk can be decreased by controlling glucose at conception and during the first trimester of pregnancy.
  
  
• Increased risk of birth defects. Research varies on how much maternal diabetes raises the likelihood of congenital malformations. The rate of major birth defects in babies of mothers with pre-existing (nongestational) diabetes ranges from 0 to 5 percent among women who receive preconception care to 10 percent among women who do not receive preconception care, according to the American Diabetes Association (ADA). Women who have type 1 or type 2 diabetes before they become pregnant are three to four times likelier than nondiabetic pregnant women to have baby with at least one birth defect, the Centers for Disease Control and Prevention (CDC) reported in 2008. Increased odds of birth defects are due to ketones (a waste product) and excess glucose (blood sugar) passing through the placenta to the developing baby, according to the ADA.
  
  
• Intrauterine growth restriction (IUGR). Individuals with diabetes have an increased risk of angiopathy (blood vessel disease) and nephropathy (kidney disease). For unknown reasons, the fetus of a woman with either of these conditions may be unable to achieve its potential size as predicted by genetics. IUGR is associated with increased risk of the following perinatal (the period around childbirth, which lasts from five months before to one month after delivery) complications:
  
  
• • Fetal mortality (death) and morbidity (injury or disease)
  • Premature birth
  • Fetal compromise during labor
  • Physician-induced early labor
  • Caesarean delivery (C-section)
    
    
• Neonatal morbidities. Infants born to mothers with diabetes also have an increased risk of dying from the following conditions:
  
  
• • Respiratory distress syndrome (RDS). A respiratory (related to breathing) disease that affects newborns.
    
    
  • Hypoglycemia. Low blood glucose.
    
    
  • Hyperbilirubinemia. A condition characterized by an excess concentration of bile pigment (bilirubin) in the blood.
    
    
• • Hypocalcemia. Insufficient calcium in the blood.
    
    
• Neonatal mortality is associated with maternal hyperglycemia (high blood glucose) during the second and third trimesters of pregnancy. It is vital that expectant mothers with diabetes carefully manage their glucose levels during this period.
  
  
• Oversized baby (macrosomia). Babies born to mothers with type 2 or gestational diabetes (diabetes that occurs during pregnancy) are two to three times more likely to have macrosomia, or oversized bodies. Macrosomia in infants is sometimes defined as a birth weight that exceeds 9 pounds (about 4 kilograms). Therefore, women with diabetes are three to four times more likely to have a C-section than nondiabetic women. Also, those who deliver vaginally are more prone to shoulder dystocia (a condition in which the positioning of the infant's shoulders makes delivery difficult) than nondiabetics. Macrosomia can also stem from maternal hyperglycemia during the second and third trimesters of pregnancy, providing yet another reason for tight glucose control during all stages of pregnancy.
  
  
• Jaundice. For unknown reasons, babies of women with diabetes are also more likely to experience jaundice, a condition in which old red blood cells accumulate because the body cannot process them fast enough. Jaundice, characterized by yellow skin, typically disappears quickly with proper treatment.
  
  
• Increased risk of diabetes in offspring. Children of mothers with type 2 diabetes or gestational diabetes have a significantly higher risk of developing obesity, prediabetes and type 2 diabetes than those with nondiabetic mothers. A child born to a parent with type 1 diabetes has a slightly higher risk of developing type 1 diabetes than the child of a nondiabetic. This risk varies depending on whether the mother or the father has diabetes and on the age of the mother.