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For Women with Diabetes:
 

Your Guide to Pregnancy
 

NATIONAL INSTITUTES OF HEALTH 

National Diabetes Information Clearinghouse 

U.S. Department 

of Health and 

Human Services 
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For Women with Diabetes: 


Your Guide to Pregnancy
 

NATIONAL INSTITUTES OF HEALTH 

National Diabetes Information Clearinghouse 
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Contents 

Introduction ........................................................................ 1
 

Taking Care of Your Baby and Yourself ......................... 2
 

Your Diabetes, Before and During
 

Your Pregnancy.................................................................. 4
 

Checking Your Baby’s Health 


During Pregnancy............................................................. 29
 

About Labor and Delivery .............................................. 32
 

After Your Baby Arrives ................................................. 34
 

For More Information ..................................................... 36
 

My Daily Blood Glucose Record.................................... 40
 

My Daily Food Record .................................................... 42
 

My Daily Physical Activity Record ................................. 44
 
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Introduction 

You have type 1 or type 2 diabetes and you are pregnant 

or hoping to get pregnant soon. You can learn what to do 

to have a healthy baby. You can also learn how to take 

care of yourself and your diabetes before, during, and 

after your pregnancy. 

For more information about diabetes, see Your 

Guide to Diabetes: Type 1 and Type 2 at www.diabetes. 

niddk.nih.gov/dm/pubs/type1and2/index.htm, which is 

also available from the National Diabetes Information 

Clearinghouse (NDIC). See page 37 for contact 

information. 

Pregnancy and new motherhood are times of great 

excitement, worry, and change for any woman. If you have 

diabetes and are pregnant, your pregnancy is automatically 

considered a high-risk pregnancy. Women carrying 

twins—or more—or who are beyond a certain age are 

also considered to have high-risk pregnancies. High risk 

doesn’t mean you’ll have problems. Instead, high risk 

means you need to pay special attention to your health 

and you may need to see specialized doctors. Millions of 

high-risk pregnancies produce perfectly healthy babies 

without the mom’s health being affected. Special care and 

attention are the keys. 

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Taking Care of Your Baby and Yourself 

Keeping your blood glucose as close to normal as 

possible before you get pregnant and during your 

pregnancy is the most important thing you can do to stay 

healthy and have a healthy baby. Your health care team 

can help you learn how to use meal planning, physical 

activity, and medications to reach your blood glucose 

goals. Together, you’ll create a plan for taking care of 

yourself and your diabetes. 

Pregnancy causes a number of changes in your body, so 

you might need to make changes in the ways you manage 

your diabetes. Even if you’ve had diabetes for years, you 

may need changes in your meal plan, physical activity 

routine, and medications. In addition, your needs might 

change as you get closer to your delivery date. 

“I took good care of my diabetes before 

and throughout my pregnancy. And 

now I have a healthy little girl!” 

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How Diabetes Can Affect You and Your Baby 

High blood glucose levels before and during pregnancy 

can 

●	 worsen your long-term diabetes complications, such 

as vision problems, heart disease, and kidney disease 

●	 increase the chance of problems for your baby, such 

as being born too early, weighing too much or too 

little, and having low blood glucose or other health 

problems at birth 

●	 increase the risk of your baby having birth defects 

●	 increase the risk of losing your baby through 


miscarriage or stillbirth
 

However, research has shown that when women with 

diabetes keep blood glucose levels under control before 

and during pregnancy, the risk of birth defects is about 

the same as in babies born 

to women who don’t have 

diabetes. 

Glucose in a pregnant woman’s 

blood passes through to the 

baby. If your blood glucose 

level is too high during 

pregnancy, so is your baby’s 

glucose level before birth. 

If your blood glucose level 

is too high, then your baby 

also gets too much glucose. 

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Your Diabetes, Before and During Your 


Pregnancy
 

As you know, in diabetes, blood glucose levels are above 

normal. Whether you have type 1 or type 2 diabetes, you 

can manage your blood glucose levels and lower the risk 

of health problems. 

If you have gestational diabetes, see What I need 

to know about Gestational Diabetes at 

www.diabetes.niddk.nih.gov/dm/pubs/gestational, 

which is also available from the NDIC. See 

page 37 for contact information. 

A baby’s brain, heart, kidneys, and lungs form during the 

first 8 weeks of pregnancy. High blood glucose levels are 

especially harmful during this early part of pregnancy. 

Yet many women don’t realize they’re pregnant until 

5 or 6 weeks after conception. Ideally, you will work 

with your health care provider to get your blood glucose 

under control before you get pregnant. 

If you’re already pregnant, see your health care provider 

as soon as possible to make a plan for taking care 

of yourself and your baby. Even if you learn you’re 

pregnant later in your pregnancy, you can still do a lot for 

your baby’s health and your own. 

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The checklist below can help you make a plan for a safe 

and healthy pregnancy. More information on each topic 

then follows. Your health care team can help you with 

tasks that are difficult for you. Tackle one thing at a time 

to keep from being overwhelmed. 

My Diabetes Care Plan for Pregnancy 

Things I can do to get ready for a healthy pregnancy 

and continue to do during my pregnancy 

Planning Ahead (see page 8) 

❑	 I’ll get my diabetes under control 3 to 6 months 

before I try to get pregnant. 

❑	 If I’m already pregnant, I’ll see my health care 

provider right away. 

My Health Care Team (see page 8) 

❑	 I’ll make sure I have the right team of health 

care providers. 

❑	 I’ll meet with members of my team. 

My Blood Glucose Levels (see page 11) 

❑	 I’ll set goals with my health care team for my 

daily blood glucose levels. 

❑	 I’ll set a goal with my health care team for my 

A1C test result. 

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❑	 I’ll learn how and when to check my blood 

glucose on my own. 

❑	 I’ll learn what to do if my blood glucose is too 

low. 

❑	 I’ll make sure my family or friends know how 

to give me glucagon for low blood glucose. 

❑	 I’ll learn what to do if my blood glucose is too 

high. 

My Ketone Levels (see page 17) 

❑	 I’ll learn how and when to check my urine or 

blood for ketones. 

❑	 I’ll learn what to do if I have ketones in my 

urine or blood. 

My Checkups (see page 19) 

I’ll get the recommended checkups and laboratory 

tests for 

❑ blood pressure 

❑ eye disease 

❑	 heart and blood vessel disease 

❑	 nervous system disease 

❑ kidney function 

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❑ thyroid disease 

❑	 average blood glucose level—the A1C test 

Smoking (see page 20) 

❑	 If I smoke, I’ll quit. 

My Meal Plan (see page 20) 

❑	 I’ll see a dietitian or diabetes educator about 

what, when, and how much to eat. 

❑	 I’ll ask whether I need vitamin and mineral 

supplements and will take them as directed. 

❑	 I’ll skip alcoholic beverages. 

My Physical Activity Routine (see page 24) 

❑	 I’ll talk with my health care team about what 

physical activities are safe for me. 

❑	 I’ll make a plan with my health care team for 

regular physical activity. 

My Medications (see page 26) 

❑	 I’ll talk with my health care team about my 

diabetes medications—what kinds, how much, 

how to take them, and when to take them. 

❑	 I’ll talk with my health care team about my 

other medications—what to keep taking and 

what to stop taking. 

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Changes in My Daily Routine (see page 27) 

❑	 I’ll make a plan for taking care of myself when 

I’m ill—what to do about food, insulin, blood 

glucose testing, and ketone testing. 

❑	 I’ll make a plan for what I need to have with 

me when I’m away from home—for several 

hours or for a longer trip. 

Planning Ahead 

Before you get pregnant, talk with your health care team 

about your wish to have a baby. Your team can work 

with you to make sure your blood glucose levels are on 

target. If you have questions or worries, bring them up. 

If you’re already pregnant, see your doctor right away. 

My Health Care Team 

Regular visits with health care providers who are experts 

in diabetes and pregnancy will ensure you get the very 

best care. Your team may include 

●	 a medical doctor who specializes in diabetes care, 

such as an endocrinologist or a diabetologist. You 

will continue to need monitoring and advice on 

glucose control throughout your pregnancy and after. 

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●	 an obstetrician-gynecologist, or “OB/GYN,” who 

has managed pregnancies of women with diabetes. 

Ask for a referral if your current gynecologist does 

not also deliver babies, as not all gynecologists do. 

When calling around to find an OB/GYN, ask about 

experience with women with diabetes. Maternalfetal medicine specialists, also called perinatologists, 

have special training to take care of women with 

high-risk pregnancies. You will see your OB/GYN 

regularly throughout your pregnancy. 

“I’m working with my health care team to 

take good care of myself and my diabetes. 

We’re doing all we can to make sure I have 

a healthy baby and a safe pregnancy. It’s 

not always easy, but I’m so motivated!” 

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●	 a nurse educator or nurse practitioner, who provides 

prenatal care and advice on managing diabetes. 

●	 a registered dietitian to help with meal planning. A 

good diet—for glucose control and nutrition—has 

never been more important than now. The phrase 

“You’re eating for two” is not about quantity as 

much as food choices. 

●	 specialists who diagnose and treat diabetes-related 

complications, such as ophthalmologists and 

optometrists for vision problems, nephrologists for 

kidney disease, and cardiologists for heart disease. 

If you are already experiencing complications from 

diabetes, you’ll need those conditions monitored 

throughout your pregnancy as well. 

●	 a social worker or psychologist to help you cope 

with stress, worry, and the extra demands of 

pregnancy. You may already have this kind of 

support, or you may suddenly need it. If anxiety 

mounts, do not hesitate to mention your uneasiness 

to your OB/GYN. Ask for a referral if you need 

more help working through issues. 

●	 a pediatrician—a doctor who cares for children. You 

might want to ask friends, family, or your health care 

team for recommendations. Many pediatricians visit 

their newest patients at the hospital soon after their 

arrival. 

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●	 a neonatologist—a doctor who cares for newborn 

babies. The hospital will assign a neonatologist if 

urgent care for your baby is needed at the hospital. 

You are the most important member of the team. Your 

health care providers can give you expert advice. But 

you’ll be responsible for the day-to-day actions needed to 

keep your diabetes under control. 

My Blood Glucose Levels 

Daily Blood Glucose Levels 

You’ll check your blood glucose levels using a blood 

glucose meter several times a day. Most health care 

providers recommend testing at least 

four times a day. Ask your health 

care provider when you should 

check your blood glucose levels 

and check off the answers on 

the next page. 

“I check my blood glucose at least four 

times a day. The results show whether I 

need to change my meal plan or insulin to 

keep my blood glucose on target.” 

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I should check my blood glucose levels 

❑ fasting—when I wake up, before I eat or drink 


anything
 

❑ before each meal 

❑ 1 hour after the start of a meal 

❑ 2 hours after the start of a meal 

❑ before bedtime 

❑ in the middle of the night—for example, 


at 2 or 3 a.m.
 

The daily goals recommended by the American Diabetes 

Association for most pregnant women are shown below. 

Write down the goals you and your health care team have 

chosen. 

When Plasma Blood Glucose 

(mg/dL) My Goals 

Before meals and when 

you wake up 80 to 110 

2 hours after the start 

of a meal Below 155 

Source: American Diabetes Association. Preconception care of women with 

diabetes. Diabetes Care. 2004;27(Supplement 1):S76–78. 

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See the chart below for goals recommended by the 

American College of Obstetricians and Gynecologists. 

When Plasma Blood Glucose 

(mg/dL) My Goals 

Fasting 105 or less 

Before meals 110 or less 

1 hour after the start 

of a meal 155 or less 

2 hours after the start 

of a meal 135 or less 

During the night Not less than 65 

Source: American College of Obstetricians and Gynecologists (ACOG) 

Committee on Practice Bulletins. ACOG Practice Bulletin Number 60: 

Pregestational diabetes mellitus. Obstetrics and Gynecology. 

2005;105(3):675–685. 

You can keep track of your blood 

glucose levels using My Daily Blood 

Glucose Record on page 40. Write 

down the results every time you 

check your blood glucose. Your 

blood glucose records can help you 

and your health care team decide 

whether your diabetes care plan is 

working. You also can use this 

form to make notes about your 

insulin and ketones. 

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The A1C Test 

Another way to see whether you’re meeting your goals is 

to have an A1C blood test. 

Results of the A1C test show your average blood glucose 

levels during the past 2 to 3 months. Write the goal you 

and your health care team have chosen below. 

Goal for My A1C Test 

Source of 

Recommendation Target Number My Goal 

American Diabetes 

Association 

4 to 6 percent—normal* 

or 

Less than 1 percent above 

the upper limits of normal* 

American College 

of Obstetricians 

and Gynecologists 

No higher than 6 percent 

*Normal values vary according to laboratory; check with your doctor. 

Low Blood Glucose 

When you’re pregnant, you’re at increased risk of having 

low blood glucose, also called hypoglycemia. When 

blood glucose levels are too low, your body can’t get the 

energy it needs. Usually hypoglycemia is mild and can 

easily be treated by eating or drinking something with 

carbohydrate. But left untreated, hypoglycemia can 

make you pass out. 

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For more information about low blood glucose, see 

Hypoglycemia at www.diabetes.niddk.nih.gov/dm/pubs/ 

hypoglycemia, which is also available from the NDIC. 

See page 37 for contact information. 

Although hypoglycemia can happen suddenly, it can 

usually be treated quickly, bringing your blood glucose 

level back to normal. Low blood glucose can be caused by 

●	 meals or snacks that are too small, delayed, 


or skipped 


●	 doses of insulin that are too high 

●	 increased activity or 


exercise 


Low blood glucose also can 

be caused by drinking too 

much alcohol. However, 

women who are trying to get 

pregnant or who are already 

pregnant should avoid all 

alcoholic beverages. 

“I keep a box of crackers on 

my bedside table. If I have 

low blood glucose during the 

night, I eat some crackers 

right away to bring my blood 

glucose back up to normal.” 

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Using Glucagon for Severe Low Blood Glucose 

If you have severe low blood glucose and pass out, you’ll 

need help to bring your blood glucose level back to 

normal. Your health care team can teach your family 

members and friends how to give you an injection of 

glucagon, a hormone that raises blood glucose levels 

right away. 

High Blood Glucose 

High blood glucose, also called hyperglycemia, can 

happen when you don’t have enough insulin or when 

your body isn’t able to use insulin correctly. High blood 

glucose can result from 

● a mismatch between food and medication 

● eating more food than usual 

● being less active than usual 

● illness 

● stress 

In addition, if your blood glucose level is already high, 

physical activity can make it go even higher. 

Symptoms of high blood glucose include 

● frequent urination 

● thirst 

● weight loss 

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Talk with your health care provider about what to do 

when your blood glucose is too high—whether it happens 

once in a while or at the same time every day for several 

days in a row. Your provider might suggest a change in 

your insulin, meal plan, or physical activity routine. 

My Ketone Levels 

When your blood glucose is too high or if you’re not 

eating enough, your body might make chemicals called 

ketones. Ketones are produced when your body doesn’t 

have enough insulin and glucose can’t be used for energy. 

Then the body uses fat instead of glucose for energy. 

Burning fat instead of glucose can be harmful to your 

health and your baby’s health. Harmful ketones can pass 

from you to your baby. Your health care provider can 

teach you how and when to test your urine or blood for 

ketones. 

If ketones build up in your body, you can develop a 

condition called ketosis. Ketosis can quickly turn into 

diabetic ketoacidosis, which can be very dangerous. 

Symptoms of ketoacidosis are 

● stomach pain 

●	 frequent urination or frequent thirst, for a day 


or more
 

● fatigue 

●	 nausea and vomiting 

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● muscle stiffness or aching 

● feeling dazed or in shock 

● rapid deep breathing 

● breath that smells fruity 

Checking Your Urine or Blood Ketone Levels 

Your health care provider might recommend you test 

your urine or blood daily for ketones and also when your 

blood glucose is high, such as higher than 200 mg/dL. 

You can prevent serious health problems by checking for 

ketones as recommended. Ask your health care team 

about when to check for ketones and what to do if you 

have them. Then check off the instructions below and fill 

in the blanks. 

I should test my urine or blood for ketones 

❑ every day before breakfast 

❑ when I’m sick 

❑ when my blood glucose is _____________ or higher 

❑ other times: _________________________________ 

If you use an insulin infusion pump, your health care 

provider might also recommend that you test for ketones 

when your blood glucose level is unexpectedly high. 

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Your health care provider might teach you how to make 

changes in the amount of insulin you take or when you 

take it. Or your provider may prefer that you call for 

advice when you have ketones. 

My Checkups 

Pregnancy can make some diabetes-related health 

problems worse. Your health care provider can talk with 

you about how pregnancy might affect any problems 

you had since before pregnancy. If you plan your 

pregnancy enough in advance, you may want to work 

for eye problems, before you get 

pregnant. Your diabetes-related 

health conditions can also 

affect your pregnancy. 

with your health care provider to arrange 

for treatments, such as laser treatment 

“I check my urine every morning for 

ketones. That’s one of the things I do to 

keep my baby and myself safe and healthy.” 

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Have a complete checkup before you get pregnant or 

at the start of your pregnancy. Your doctor should 

check for 

●	 high blood pressure, also called hypertension 

●	 eye disease, also called diabetic retinopathy 

●	 heart and blood vessel disease, also called 


cardiovascular disease
 

●	 nerve damage, also called diabetic neuropathy 

●	 kidney disease, also called diabetic nephropathy 

● thyroid disease 

You’ll also get regular checkups throughout your 

pregnancy to check your blood pressure and average 

blood glucose levels and to monitor the protein in your 

urine. 

Smoking 

Smoking can increase your chance of having a stillborn or 

premature baby. Smoking is also especially harmful for 

people with diabetes. If you smoke, talk with your health 

care provider about how to quit. 

My Meal Plan 

If you don’t already see a dietitian, now would be an 

excellent time to start. Your dietitian can help you 

learn what to eat, how much to eat, and when to eat. 

Together, you’ll create a meal plan tailored to your 

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needs, usual schedule, food preferences, medical 

conditions, medications, and physical fitness routine. 

Many women need changes in their diet, such as extra 

calories and protein, during pregnancy. You might need 

to see your dietitian every few months during pregnancy 

as your needs change. Eating a well-balanced diet helps 

ensure that you and your baby are healthy. 

How Much to Eat 

Talk with your dietitian about how many servings to 

have at each meal and snack. Your dietitian can also 

provide advice about portion sizes. Your meal plan will 

be based on how many calories you need for pregnancy 

and your goals for weight gain during the pregnancy. For 

most women whose weight is in the normal range before 

“My dietitian helped me include my favorite foods in my meal plan.” 

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pregnancy, gaining 25 to 35 pounds is recommended. If 

you’re underweight or overweight at the start of your 

pregnancy, your weight goal may differ. For overweight 

women, the recommended weight gain is no more than 

15 pounds. 

“Eating small meals and snacks throughout the day helps 

keep my blood glucose under control.” 

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Vitamin and Mineral Supplements 

Your health care team will tell you whether you need to 

take a vitamin and mineral supplement before and during 

pregnancy. Many pregnant women need supplements 

because their diets don’t supply enough of the following 

important vitamins and minerals: 

• iron—to help make extra blood for pregnancy and 

for the baby’s supply of iron 

• folic acid—to prevent birth defects in the brain and 

spinal cord 

• calcium—to build strong bones 

Alcoholic Beverages 

You should avoid alcoholic beverages while you’re trying 

to get pregnant and throughout pregnancy. When you 

drink, the alcohol also goes to your baby. Alcohol can 

lead to serious, lifelong problems for your baby. 

For more information about eating and diabetes, 

see What I need to know about Eating and Diabetes at 

www.diabetes.niddk.nih.gov/dm/pubs/eating_ez, which 

is also available from the NDIC. See page 37 for 

contact information. 

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You can keep track of what you 

eat and drink using My Daily Food 

Record on page 42. Your food 

records can help you and your health 

care team see whether your diabetes 

care plan is working. 

Artificial Sweeteners 

Artificial sweeteners can be used in moderate amounts. 

If you choose to use sweeteners, talk with your dietitian 

about how much to have. 

My Physical Activity Routine 

Daily physical activity can help you reach your target 

blood glucose levels. It can also help you reach your 

blood pressure and cholesterol target levels, relieve 

stress, improve muscle tone, strengthen your heart and 

bones, and keep your joints flexible. Talk with your 

health care team about moderate physical activity, such 

as walking or swimming. Consider whether you have 

any health problems and which exercises would be 

best for you. Your health care team may advise you to 

avoid exercises that increase your risk of falling, such as 

downhill skiing. 

A sensible goal for most women is to aim for 30 minutes 

or more of activity, most days of the week. If you’ve been 

active before pregnancy, you may be able to continue 

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with a more moderate version of your usual exercise 

routine. But if you haven’t been active, start with an 

activity such as walking. Vigorous physical activity, 

such as walking briskly, can lead to low blood glucose. 

Pregnant women sometimes do not have the typical signs 

of low blood glucose. 

For more information about physical activity and 

diabetes, see What I need to know about Physical 

Activity and Diabetes at www.diabetes.niddk.nih.gov/ 

dm/pubs/physical_ez, which is also available from the 

NDIC. See page 37 for contact information. 

“I wasn’t very active before I got pregnant. 

But my doctor said that walking every day 

would be safe and good for me and my baby.” 

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You can keep track of your physical 

activity using My Daily Physical 

Activity Record on page 44. Your 

physical activity records can help you 

and your health care team see whether 

your diabetes care plan is working. 

My Medications 

Medications for Diabetes 

During pregnancy, the safest diabetes medication is 

insulin. Your health care team will work with you to 

make a personalized plan for your insulin routine. 

If you’ve been taking diabetes pills to control your 

blood glucose levels, you’ll need to stop taking them. 

Researchers have not yet determined whether diabetes 

pills are safe for use throughout pregnancy. Instead, 

your health care team will show you how to take insulin. 

If you’re already taking insulin, you might need a change 

in the kind, the amount, and how or when you take it. 

The amount of insulin you take is likely to increase as 

you go through pregnancy because your body becomes 

less able to respond to the action of insulin, a condition 

called insulin resistance. Your insulin needs may double 

or even triple as you get closer to your delivery date. 

Insulin can be taken in several ways. Your health care 

team can help you decide which way is best for you. 

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For more information about insulin, see What 

I need to know about Diabetes Medicines at 

www.diabetes.niddk.nih.gov/dm/pubs/medicines_ez, 

which is also available from the NDIC. See page 37 

for contact information. 

Other Medications 

Some medications are not safe during pregnancy and 

should be discontinued before you get pregnant. Tell 

your health care provider about all the medications you 

currently take, such as those for high cholesterol and 

high blood pressure. Your provider can tell you which 

medications to stop taking. 

Changes in My Daily Routine 

Sick Days 

When you’re ill, your blood glucose levels can rise 

rapidly. Diabetic ketoacidosis, a dangerous condition for 

you and your baby, can occur. Talk with your health care 

team about what you should do if you get sick. Be sure 

you know 

● what to do if you’re nauseated or vomiting 

● how often you should check your blood glucose 

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●	 how often you should check your urine or blood for 

ketones 

●	 when you should call your health care provider 

Being Away from Home 

When you’re away from home—for several hours or for 


a longer trip—you’ll want to be prepared for problems. 


Make sure you always have the following 


with you:
 

●	 a snack or a meal 

●	 food or drinks to treat low blood glucose 

●	 your diabetes medicines and supplies 

●	 your blood glucose meter 


and supplies
 

●	 your glucagon kit 

●	 your health care team’s 


phone numbers for 


emergencies
 

“When I’m not feeling well, I check my 

blood glucose more often than usual. 

I know that being sick can make my 

blood glucose level go too high.” 

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Checking Your Baby’s Health During 


Pregnancy
 

You are likely to have tests all through your pregnancy 

to check your baby’s health. Your health care team can 

tell you which of the following tests you’ll have and when 

you might have them. Your health care provider might 

also suggest other tests. If certain diseases or conditions 

run in your family, you might meet with a genetic 

counselor. The counselor may recommend tests based 

on your family history and can explain the risk of certain 

conditions for your baby. 

Maternal Blood Screening Test 

The maternal blood screening test is also called the 

multiple marker screen test, the triple screen, or quad 

screen. It measures several substances in your blood. 

Results can tell you whether your baby is at risk for 

spinal cord and brain problems, Down syndrome, and 

other birth defects. If the results show an increased 

risk for problems, additional tests such as ultrasound or 

amniocentesis can provide more information. 

Ultrasound 

Ultrasound uses sound waves to provide a picture 

of areas inside the body. The picture produced by 

ultrasound is called a sonogram. Ultrasound can show 

the baby’s size, position, structures, and sex. It can also 

29 
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help estimate age, evaluate growth, and show some types 

of birth defects. 

Fetal Echocardiogram 

The fetal echocardiogram uses ultrasound to check for 

problems in the structures of the baby’s heart. 

Amniocentesis 

Amniocentesis uses a thin needle inserted through the 

abdomen into the uterus to obtain a small amount of the 

fluid that surrounds the baby. Cells from the fluid are 

grown in a lab and then analyzed. Amniocentesis can 

help tell whether your baby has health problems and if 

your baby’s lungs have finished developing. Developed 

lungs are needed for the baby to breathe without help 

after delivery. 

Chorionic Villus Sampling (CVS) 

CVS involves a thin needle inserted into the placenta to 

obtain cells. Cells then are analyzed to look for health 

problems. Ultrasound is used to guide the needle into 

the placenta, either through the vagina and cervix or 

through the abdomen and uterus. The placenta is 

composed of tissue and blood vessels that develop to 

attach the baby to the mother’s uterus so the developing 

baby can get nutrition from mom. 

30 
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Kick Counts (Fetal Movement Counting) 

Counting kicks is an easy way to keep track of your baby’s 

activity. You’ll count how many times the baby moves 

during a certain period of time. 

Nonstress Test 

A fetal monitor checks whether your baby’s heart rate 

increases as it should when the baby is active. 

Biophysical Profile 

Ultrasound checks your baby’s muscle tone, breathing, 

and movement to obtain a biophysical profile. 

Ultrasound also estimates the amount of amniotic fluid 

surrounding the baby. 

Contraction Stress Test 

This test measures the baby’s heart rate during 

contractions using a fetal monitor. The results can 

help your doctor decide whether the baby needs to be 

delivered early. 

31 
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About Labor and Delivery 

Timing of Delivery 

Your health care team will consider your health, 

your baby’s health, and the state of your pregnancy in 

deciding how and when delivery should occur. Some 

doctors prefer to deliver babies of women with diabetes 

1 or 2 weeks before their due dates to lower the risk 

of problems. Your doctor may recommend inducing 

labor before your due date or delivering the baby 

surgically using a cesarean section, also called a c-section. 

However, most women with diabetes have the option of 

delivering vaginally. You’ll want to talk with your health 

care team about your options well ahead of time. 

The factors your health 

care team will consider 

in deciding what type 

of delivery is best for 

you and your baby may 

include 

●	 your baby’s size 


and position
 

●	 your baby’s lung 


maturity
 

● your baby’s 

movements “I talked with my doctor way before

I was due about my options for 

delivering my baby.” 

32
 
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● your baby’s heart rate 

● the amount of amniotic fluid 

● your blood glucose and blood pressure levels 

● your general health 

Blood Glucose Control During Labor and Delivery 

Keeping your blood glucose levels under control helps 

ensure your baby won’t have low blood glucose after 

birth. Because you’ll be physically active when you’re in 

labor, you may not need much insulin. Hospital staff will 

check your blood glucose levels frequently. Some women 

take both insulin and glucose, as well as fluids, through 

an intravenous (IV) line during labor. Infusing insulin 

and glucose directly into your bloodstream through a 

vein provides good control of blood glucose levels. If you 

are using an insulin pump, you might continue to use it 

throughout labor. 

If you are having a c-section, your blood glucose levels 

may increase because of the stress of surgery. Your 

health care team will closely monitor your blood glucose 

levels and will likely use an IV for insulin and glucose to 

keep your levels under control. 

33 
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After Your Baby Arrives 

About Breastfeeding 

Breastfeeding is highly recommended for the babies of 

women with diabetes. Breastfeeding provides the best 

nutrition and helps your baby stay healthy. 

“Even though I have diabetes, I can still breastfeed my baby. My 

milk gives my baby exactly what he needs.” 

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Your Meal Plan 

If you’re breastfeeding, you might need more calories 

each day than you needed during your pregnancy. Your 

dietitian can provide personalized recommendations and 

answer any questions you have about what, when, and 

how much to eat. 

Your Medications 

After you’ve given birth, you might need less insulin than 

usual for several days. Breastfeeding can also lower 

the amount of insulin you need. Diabetes pills are not 

recommended during breastfeeding. 

Low Blood Glucose 

You’ll be at increased risk for low blood glucose, 

especially if you’re breastfeeding. You might need to 

have a snack before or after you breastfeed your baby. 

Your health care team may suggest that you check your 

blood glucose more often than usual. 

35 
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For More Information 

How can I find diabetes educators and dietitians? 

Diabetes Educators 

To find diabetes teachers—nurses, dietitians, and other 

health professionals—call the American Association of 

Diabetes Educators toll-free at 1–800–TEAMUP4 

(832–6874). Or go to www.diabeteseducator.org and see 

the “Find a Diabetes Educator” section. 

Dietitians 

To find a dietitian, call the American Dietetic 

Association’s National Center for Nutrition and Dietetics 

at 1–800–877–1600. Or go to www.eatright.org and see 

the “Find a Nutrition Professional” section. 

36
 
37

Where can I get more information about diabetes?

National Diabetes Information Clearinghouse

1 Information Way 

Bethesda, MD 20892–3560 

Phone: 1–800–860–8747

Fax: 703–738–4929

Email: ndic@info.niddk.nih.gov

Internet: www.diabetes.niddk.nih.gov

07241 Diabetes and Pregnancy 37 3/21/08 2:03/21/08 2:0
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National Diabetes Education Program 

1 Diabetes Way 

Bethesda, MD 20892–3560 

Phone: 1–800–438–5383 

Fax: 703–738–4929 

Email: ndep@mail.nih.gov 

Internet: www.ndep.nih.gov 

American Diabetes Association 

National Service Center 

1701 North Beauregard Street 

Alexandria, VA 22311–1742 

Phone: 1–800–DIABETES (342–2383) 

Fax: 703–549–6995 

Email: AskADA@diabetes.org 

Internet: www.diabetes.org 

Juvenile Diabetes Research Foundation International 

120 Wall Street 

New York, NY 10005–4001 

Phone: 1–800–533–CURE (2873) 

Fax: 212–785–9595 

Email: info@jdrf.org 

Internet: www.jdrf.org 

38 
07241 Diabetes and Pregnancy 39 07241 Diabetes and Pregnancy 39 3/19/08 9:2

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Where can I get more information about 

pregnancy? 

National Institute of Child Health & Human 

Development Information Resource Center 

P.O. Box 3006 

Rockville, MD 20847 

Phone: 1–800–370–2943 

Fax: 301–984–1473 

Email: NICHDInformationResourceCenter@mail.nih.gov 

Internet: www.nichd.nih.gov 

The U.S. Government does not endorse or favor any specific 

commercial product or company. Trade, proprietary, or 

company names appearing in this document are used only 

because they are considered necessary in the context of 

the information provided. If a product is not mentioned, 

the omission does not mean or imply that the product is 

unsatisfactory. 

39 
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My Daily Blood Glucose Record 

Make a copy of this form for each week of your pregnancy. 

Use this form to keep track of your blood glucose numbers, 

your urine or blood ketone test results, and your insulin. 

Week 

Starting: 

_____________ 

Fasting 

Blood 

Glucose 

Urine or 

Blood 

Ketones 

Insulin 

Breakfast 

Blood 

Glucose 

Insulin 

Other 

Blood 

Glucose 

Insulin 

Lunch 

Blood 

Glucose 

Insulin 

O

B

Gl

Monday 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Tuesday 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Wednesday 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Thursday 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Friday 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Saturday 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Sunday 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

40
 
07241 Diabetes and Pregnancy 41 07241 Diabetes and Pregnancy 41 3/19/08 9:2

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Insulin 

Dinner 

Blood 

Glucose 

Insulin 

Other 

Blood 

Glucose 

Insulin 

Bedtime 

Blood 

Glucose 

Insulin 

Other 

Blood 

Glucose 

Notes 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

Time: 

Amount: 

41
 
07241 Diabetes and Pregnancy 42 07241 Diabetes and Pregnancy 42 3/19/08 9:2

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My Daily Food Record 

Make a copy of this form for each week of your pregnancy. 

Use this form to keep track of what, when, and how much 

you eat and drink. 

Week Starting: 

________________________ Breakfast Mid-morning Snack 

Monday 

Tuesday 

Wednesday 

Thursday 

Friday 

Saturday 

Sunday 

42
 
07241 Diabetes and Pregnancy 43 07241 Diabetes and Pregnancy 43 3/19/08 9:2

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Lunch Mid-afternoon Snack Dinner Bedtime Snack 

43
 
07241 Diabetes and Pregnancy 44 07241 Diabetes and Pregnancy 44 3/19/08 9:2

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My Daily Physical Activity Record 

Make a copy of this form for each week of your pregnancy. 

Use this form to keep track of what kind of physical activity 

you do and how long you do it. 

Week Starting: 

__________________ Type of Activity Minutes 

Monday 

Tuesday 

Wednesday 

Thursday 

Friday 

Saturday 

Sunday 

44
 
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National Diabetes Information 


Clearinghouse
 

1 Information Way 

Bethesda, MD 20892–3560 

Phone: 1–800–860–8747 

Fax: 703–738–4929 

Email: ndic@info.niddk.nih.gov 

Internet: www.diabetes.niddk.nih.gov 

The National Diabetes Information Clearinghouse (NDIC) is a 

service of the National Institute of Diabetes and Digestive and 

Kidney Diseases (NIDDK). The NIDDK is part of the National 

Institutes of Health of the U.S. Department of Health and 

Human Services. Established in 1978, the Clearinghouse provides 

information about diabetes to people with diabetes and to their 

families, health care professionals, and the public. The NDIC 

answers inquiries, develops and distributes publications, and works 

closely with professional and patient organizations and Government 

agencies to coordinate resources about diabetes. 

Publications produced by the Clearinghouse are carefully reviewed 

by both NIDDK scientists and outside experts. This booklet was 

reviewed by Boyd E. Metzger, M.D., Tom D. Spies Professor of 

Metabolism and Nutrition, Division of Endocrinology, Metabolism 

& Molecular Medicine, Northwestern University Feinberg School 

of Medicine, and Julie M. Slocum Daley, R.N., M.S., C.D.E., Women & 

Infants’ Hospital of Rhode Island. 

This publication is not copyrighted. The Clearinghouse encourages 

users of this publication to duplicate and distribute as many copies as 

desired. 

This booklet is also available at www.diabetes.niddk.nih.gov. 

This publication may contain information about medications used to treat 

a health condition. When this publication was prepared, the NIDDK 

included the most current information available. Occasionally, new 

information about medication is released. For updates or for questions 

about any medications, please contact the U.S. Food and Drug Administration at 1–888–INFO–FDA (463–6332), a toll-free call, or visit their 

website at www.fda.gov. Consult your doctor for more information. 
07241 Diabetes and Pregnancy 46 07241 Diabetes and Pregnancy 46 3/19/08 9:2

3/19/08 9:2

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 08–5491 

February 2008