context: Women who have diabetes before they get pregnant have special health concerns. In addition to the new demands that a pregnancy will put on your body, it will also affect your blood sugar levels and diabetes medications. If you're thinking about having a baby, take steps to lessen the risks for both you and your child. A pre-conception counseling appointment will help you be physically and emotionally prepared for pregnancy. Meet with your doctor to find out if your diabetes is controlled well enough for you to stop your birth control method. A blood test called the glycosylated hemoglobin test ( Hb A1c, or just A1c) can show how well it's been going over the past 8 to 12 weeks. Other medical tests can help prevent complications during pregnancy: Urinalysis to check for kidney problems Cholesterol and triglyceride blood tests Eye exam to see if you have glaucoma, cataracts, or retinopathy Electrocardiogram Blood work to make sure your kidneys and liver are working Foot exam High blood sugar levels early in the pregnancy (before 13 weeks) can cause birth defects. They also can increase the risks of miscarriage and diabetes-related complications. But many women don't know they're pregnant until the baby has been growing for 2 to 4 weeks. That's why you should have good control of your blood sugar before you start trying to conceive. Keep blood glucose levels within the ideal range: 70 to 100 mg/d L before meals Less than 120 mg/d L 2 hours after eating 100-140 mg/d L before your bedtime snack Use your meals, exercise, and diabetes medications to keep a healthy balance. Babies born to women with diabetes are often much bigger, a condition called "macrosomia." Because their mothers have high blood sugar levels, they get too much sugar through the placenta. The baby's pancreas senses it and makes more insulin to use it up. That extra sugar gets converted to fat, making a large baby. Many hospitals keep an eye on babies of mothers with diabetes for several hours after birth. If you regularly have high blood sugar levels while you're pregnant (and especially in the 24 hours before delivery), your baby may get dangerously low blood sugar right after they're born. Their insulin is based on your high sugar, and when it's suddenly taken away, their blood sugar level drops quickly and they'll need glucose to balance it out. Their calcium and magnesium levels may be off, too. Those can be fixed with medication. Some babies are too big to be delivered vaginally, and you'll need a cesarean delivery or c-section. Your doctor will keep an eye on your baby's size so you can plan for the safest way to give birth. If you use insulin to control your diabetes, your doctor can tell you how to adjust your dose. Your body will probably need more while you're pregnant, especially during the last 3 months. If you take a pill, you may need to switch to insulin. It may not be safe to use some drugs, or you may get better sugar control. Changing what and how you eat will help you avoid problems with your blood sugar levels. You'll also need to include more calories for your growing baby. Your doctor or diabetes educator can help you figure out how to do that safely. Women with well controlled diabetes often go full-term without any problems. However, many doctors prefer to plan for an early delivery, usually around weeks 38-39. Labor can be a stressful time for you and the baby. If you've been using insulin during your pregnancy, insulin needs will continue through labor. It's typically continued with an IV or with a pump if you are already on a pump. Right after delivery, your need for insulin will likely drop quickly.