Pregnancy is a time of wonder and amazement—and lots of bodily changes that seem to defy explanation. (Think of the bizarre cravings and food aversions. The weird skin and hair changes. Oh, and your feet will probably get bigger, too.) Many pregnant women experience caroming hormonal mood swings, but for women with preexisting diabetes, those nine months are also packed with crazy blood glucose ups and downs. “I spent the entire first trimester with my face buried in the fridge,” says Kerri Sparling, 31, who has type 1 diabetes and whose daughter was born in April. “I was low all the time. It wasn’t until probably the second trimester that the insulin resistance kicked in. Everything I ate, the insulin didn’t cover it.”

It’s true that diabetes makes pregnancy more complicated. But it’s just as true that, with good care and planning, women with both type 1 and type 2 can have safe pregnancies—and healthy babies.

First Things First
Before you get down to baby-making business, there are a few lifestyle changes you may need to make. Here are some ideas for how you can reach your pre-pregnancy goals.

Stop Smoking
Pick up a hobby that keeps your hands busy when cravings hit.

Get Your A1C Under 7%
Test often—and review the results with your doctor.

Prevent Birth Defects
Take 400 to 800 micrograms of folic acid daily.

Eat Nutrient-Rich Foods
Book an appointment with a registered dietitian to learn about healthy eating.

Ditch Alcohol
Instead of wine, for example, try a nonalcoholic spritzer made from seltzer water and a splash of juice.

Skip possibly Unsafe Foods
Swear off raw meat, lunch meat, raw fish and smoked seafood, soft cheeses like brie and gorgonzola, fish with high mercury levels (like tuna), and unpasteurized milk.

Exercise More
Take a 30-minute walk at lunchtime.

Stage 1: Before You Begin

It may seem counterintuitive, but you’ll actually want to see your doctor before you start trying to get pregnant. This is called a “preconception visit,” and it’s where you’ll get a lot of information about what pregnancy may bring (remember to take notes!). It’s also a chance for your doctor to assess your general health and adjust your regimen accordingly. Depending on how you manage your diabetes, you may need to see both an endocrinologist and an ob-gyn at this point. Preexisting diabetes automatically makes your pregnancy “high risk,” even if it goes along without a hitch. An obstetrician who specializes in such pregnancies will be more accustomed to treating women with diabetes. And remember, you’ll probably be coming into the office a lot once you get pregnant (as much as once or even twice a week in the third trimester), so if you’re choosing new docs you may want to consider how convenient they are to where you live or work. 

In addition to a higher chance of miscarriage, there are two major types of risks that a mother’s diabetes poses to a developing baby. The first occurs in the earlier part of the pregnancy, when organs are beginning to grow and serious birth defects can occur. The second concern comes later in the pregnancy, when babies of diabetic mothers run a risk of growing too big (this is known as macrosomia), which can create problems for delivery and harm the newborn.

All of these problems are best prevented, first and foremost, by keeping your blood glucose in check. This is why your A1C (average blood glucose over the past two to three months) should be below 7 percent before you conceive. Some doctors advise going lower, say 6.5 or 6. During the pre-conception visit, you and your doctor will determine a safe A1C goal and devise a way to get there before pregnancy. If you have type 2 diabetes that is treated with diet and exercise, oral medications, or a combination, you may need to go on insulin for the duration of the pregnancy, or even before.

Your doctor may also discuss whether you need to lose weight. If so, “that’s probably the best thing besides getting blood sugar under control,” says Deborah L. Conway, MD, assistant professor in the Department of Obstetrics and Gynecology at the University of Texas Health Sciences Center in San Antonio. “[For obese women,] any amount of weight loss prior to pregnancy is going to reduce the impact that just the obesity alone has on pregnancy.” Obesity increases pregnancy complications like high blood pressure and can also up a woman’s chances of having a cesarean section. Your doctor will advise you on how much to lose before trying to get pregnant.

About three months before you start attempting to conceive, you will also need to begin taking 400 to 800 micrograms of folic acid daily, which prevents birth defects like spina bifida. You can find folic acid supplements in the vitamin aisle, or you can get a prescription from your doctor. Some prenatal vitamins don’t have enough folic acid, so check before you use one as your only source of the essential nutrient. Your doctor will also advise you about which current medications you need to quit because they pose a risk to the baby. Statins, ACE inhibitors, and many other drugs—including some over-the-counter meds, like ibuprofen—aren’t considered safe for use in pregnancy. When in doubt, ask your doctor or nurse if a particular medication or supplement is OK.

Before you become pregnant, you will need certain tests. Some of these apply to any woman contemplating pregnancy. For example, your doctor will want to make sure that you’ve had immunizations. And you and the baby’s father may choose to undergo genetic testing, to see if you carry predispositions to any conditions. For women with diabetes, there are some additional screenings. Besides an A1C test, you should have your cholesterol, thyroid function, and blood pressure checked. Hypothyroidism, or abnormally low thyroid function, is quite common, especially in people with type 1 diabetes, and may affect the developing baby’s nervous system. It should be treated before you conceive; if you take thyroid hormone replacement, you will probably need a higher dose during pregnancy. Also, talk with your doctor about safe blood pressure–lowering medications since many are off limits to expectant mothers.

Women with diabetes should also get a comprehensive eye exam before conceiving. Pregnancy can stimulate the development of the eye disease retinopathy, a common complication of diabetes. If the disease becomes too advanced, it can prevent a vaginal delivery, because pushing during labor can further damage the eyes. Women with diabetes will also have their kidney function tested before pregnancy. Since pregnancy can harm their kidneys, women with advanced kidney disease may be advised to avoid pregnancy. Women with both diabetes and heart disease may also be poor candidates for pregnancy.

Finally, while diabetes itself doesn’t affect fertility, polycystic ovary syndrome (PCOS), which is associated with type 2 diabetes, can. If you’re having trouble getting pregnant, your doctor can recommend fertility treatments, which are as safe for women with diabetes as they are for women without.

Next: Stage 2—The Nine-Month Stretch