Preexisting diabetes

About 9 out of 100 women (9 percent) in the United States have diabetes. Diabetes is a condition in which your body has too much sugar (called glucose) in the blood. Glucose is your body's main source of fuel for energy.

Unlike gestational diabetes, preexisting diabetes (diabetes you have before pregnancy) doesn’t happen just during pregnancy. You can develop it any time in your life.

If you have diabetes and are pregnant or trying to get pregnant, your health care provider needs to take extra special care of you. Pregnancy for a woman with preexisting diabetes is called high risk. This means you may have complications during pregnancy, so your provider needs to monitor you and your baby closely.

Just because your pregnancy is called high risk doesn’t mean for sure that you’ll have problems. It just means that your provider pays special attention to your health and may work with other specialized health providers to help you have a healthy pregnancy.

Can diabetes cause problems for a baby during pregnancy?
Yes. Women who have diabetes are almost as likely as women who don’t have diabetes to have a healthy baby. But they need to control their blood sugar levels before and during pregnancy. Here’s why:

  • High blood sugar levels can be harmful to babies during the first few weeks of pregnancy. This is the time when a baby’s brain, heart, kidneys and lungs begin to form.
  • Babies of women with preexisting diabetes are more likely than other babies to have a birth defect, including heart defects and neural tube defects. A birth defect is a health condition that is present at birth. Birth defects change the shape or function of one or more parts of the body. They can cause problems in overall health, how the body develops, or in how the body works. The neural tube is the part a developing baby that becomes the brain and spinal cord.
  • The baby may be very large—10 pounds or more. This weight makes vaginal birth more difficult and puts the baby in danger of getting injured during birth.
  • Women with preexisting diabetes are more likely than women who don’t have diabetes to have a miscarriage or stillbirth. Miscarriage is the death of a baby in the womb before 20 weeks of pregnancy. Stillbirth is the death of a baby in the womb after 20 weeks of pregnancy but before birth.

If you have diabetes, what can you do before you get pregnant to help you have a healthy pregnancy?
If you’re planning to get pregnant, here’s what you can do to help you get ready for pregnancy:

  • Get your diabetes under control 3 to 6 months before trying to get pregnant. It’s important for anyone living with diabetes to manage their blood sugar. But it’s really important for women who want to get pregnant.
  • Take a multivitamin with 400 micrograms of folic acid in it every day. Because you have diabetes, your health care provider may increase your daily dose of folic acid to help reduce the risk of birth defects. A birth defect is a health condition that is present at birth. Birth defects change the shape or function of one or more parts of the body. They can cause problems in overall health, how the body develops, or in how the body works.
  • Tell your health provider about any medicines you take to make sure they’re OK to take during pregnancy. Your provider may want to change some medicines if they’re not safe for you and your baby.
  • Stay physically active. If you’re not, talk to your provider about adding physical activity to your daily routine.
  • Talk to a dietitian or a diabetes educator to help you create a healthy meal plan. These people have special training in helping people with diabetes choose healthy foods to keep their blood sugar under control.
  • Meet with any specialists that your health provider recommends. These experts can help you manage your diabetes and any complications that may come up during pregnancy. Specialists include a perinatologist, who treats women with high-risk pregnancies, and an endocrinologist, who treats women with diabetes and other health conditions.

How is preexisting diabetes treated during pregnancy?
During pregnancy, the safest diabetes treatment is insulin. Insulin is a hormone that helps the body control its blood sugar. Some people with diabetes have trouble making or responding to insulin and may need other treatment.

Your health provider can work with you to create a personal plan for your insulin treatment:

  • If you’re taking diabetes pills, your provider can switch you to insulin. Diabetes pills aren’t recommended during pregnancy.
  • During pregnancy, some women with preexisting diabetes become less able to respond to insulin. This is called insulin resistance. If you’re insulin resistant, you may need to change the kind and amount of insulin you take.
  • As you get farther along in your pregnancy, your body may need more insulin than it did in early pregnancy. You may need double or even triple the amount of insulin you normally use.

Here are some other things you can do to help manage your diabetes and have a healthy pregnancy:

  • Tell your provider about all medicines you take, even medicines that aren’t related to your diabetes. Some medicines aren’t safe for your or your baby during pregnancy. Your provider may need to change some of your medicines to ones that are OK for use during pregnancy.
  • If you don’t already have a dietician, find one. Your provider can recommend one for you. A dietician can help you learn what, how much and how often you should eat. She can help you make meal plans and help you know the right amount of weight to gain during pregnancy. Check with your insurance company to see if it covers treatment from a dietician.
  • Do something active every day. With your health provider’s OK, daily physical activity can help you manage your diabetes. It also can help with other health conditions you may have, such as high blood pressure or high cholesterol. Most healthy pregnant women need at least 2 1/2 hours of physical activity every week.

If you have preexisting diabetes, is it OK to breastfeed?
Yes. If you have diabetes, it’s safe to breastfeed your baby. Breast milk is the best food for your baby during the first year of life. It helps him grow healthy and strong.

Here are some tips about breastfeeding if you have preexisting diabetes:

  • Talk to your dietician about breastfeeding. You may need help to create a new meal plan to make sure you get all the calories you need to support breastfeeding.
  • Talk to your provider about the amount of insulin you need. You may need less insulin than usual for a few days after giving birth. And breastfeeding can lower the amount even further. It’s safe to take insulin while breastfeeding.
  • Don’t take diabetes pills. They’re not recommended for breastfeeding moms.
  • Eat a healthy snack before or after breastfeeding.
  • Monitor your blood sugar closely. You provider may want you to check your glucose more often than usual.

What are hypoglycemia and hyperglycemia?
Hypoglycemia (also called low blood glucose) is when blood glucose levels are too low. When blood glucose levels are low, your body can’t get the energy it needs. Hyperglycemia (also called high blood glucose) is when your body doesn’t have enough insulin or can’t use insulin correctly. Both of these conditions are common in women with preexisting diabetes.

Hypoglycemia is usually mild and easily treated by eating or drinking something with sugar in it. If it’s not treated, it can cause you to pass out. Hypoglycemia can be caused by:

  • Not eating enough. This may mean eating meals or snacks that are too small, or skipping or delaying meals or snacks.
  • Taking too much insulin
  • Getting too much physical activity

If you have hyperglycemia, you may need to change the amount of insulin you take, your meal plan or the amount of physical activity you get. You may have hyperglycemia if you:

  • Need to go to urinate often
  • Are thirsty
  • Lose weight suddenly

Hyperglycemia can be caused by:

  • Problems with the amount of food you eat and diabetes medicine you take
  • Eating the wrong kinds of foods or more food than usual
  • Being less active than usual
  • Having an illness
  • Stress

Your provider can monitor you for these conditions during pregnancy to make sure you and your baby stay healthy.

Last reviewed October 2012

Most common questions

What is mononucleosis?

Mononucleosis (also called mono) is an infection usually caused by the Epstein-Barr virus (EBV). It’s sometimes caused by another virus called cytomegalovirus (CMV). EBV and CMV are part of the herpes virus family. Mono is most common in teenagers and young adults, but anyone can get it. Mono is called the “kissing disease” because it’s usually passed from one person to another through saliva. In addition to kissing, it can also be passed through sneezing, coughing or sharing pillows, drinks, straws, and toothbrushes.

You can have mono without having any symptoms. But even if you don’t get sick, you can still pass it to others. Symptoms can include:

  • Achy muscles
  • Belly pain
  • Fatigue (feeling tired all the time)
  • Fever
  • Sore throat
  • Swollen glands in your neck

If your symptoms don’t go away or get worse, tell your health care provider. He’ll most likely do a physical exam and test your blood to find out for sure if you have mono.

There’s no vaccine to prevent mono. There’s also no specific treatment. The best care is to take it easy and get as much rest as you can. It may take a few weeks before you fully recover.

Can Rh factor affect my baby?

The Rh factor may be a problem if mom is Rh-negative but dad is Rh-positive. If dad is Rh-negative, there is no risk.

If your baby gets her Rh-positive factor from dad, your body may believe that your baby's red blood cells are foreign elements attacking you. Your body may make antibodies to fight them. This is called sensitization.

If you're Rh-negative, you can get shots of Rh immune globulin (RhIg) to stop your body from attacking your baby. It's best to get these shots at 28 weeks of pregnancy and again within 72 hours of giving birth if a blood test shows that your baby is Rh-positive. You won't need anymore shots after giving birth if your baby is Rh-negative. You should also get a shot after certain pregnancy exams like an amniocentesis, a chorionic villus sampling or an external cephalic version (when your provider tries to turn a breech-position baby head down before labor). You'll also want to get the shot if you have a miscarriage, an ectopic pregnancy or suffer abdominal trauma.

I had a miscarriage. How long should I wait to try again?

Before getting pregnant again, it's important that you are ready both physically and emotionally. If you don't need tests or treatments to discover the cause of the miscarriage, it's usually OK for you to become pregnant after one normal menstrual cycle. However, it may take longer for you to feel emotionally ready to be pregnant again. Everyone responds differently to a miscarriage. Only you will know when you are ready to try to get pregnant again.

Are gallstones common during pregnancy?

Not common, but they do happen. Elevated hormones during pregnancy can cause the gallbladder to function more slowly, less efficiently. The gallbladder stores and releases bile, a substance produced in the liver. Bile helps digest fat. When bile sits in the gallbladder for too long, hard, solid nuggets called gallstones can form. The stones can block the flow of bile, causing indigestion and sometimes serious pain. Staying at a healthy weight during pregnancy can help lower your risk of gallstones. Exercise and eating foods that are low in fat and high in fiber, like veggies, fruits and whole grains, can help, too. Symptoms of gallstones include nausea, vomiting and intense, continuous abdominal pain. Treatment during pregnancy may include surgery to remove the gallbladder. Gallstones in the third trimester can be managed with a strict meal plan and pain medication, followed by surgery several weeks after delivery.

©2013 March of Dimes Foundation. The March of Dimes is a non-profit organization recognized as tax-exempt under Internal Revenue Code section 501(c)(3).