In the past,  it was common for women with diabetes who became pregnant to experience serious problems, such as miscarriage, stillbirth, or a baby with birth defects. Today, it is very common for women with diabetes - either type 1 or type 2 - to have safe and healthy pregnancies. Although women with diabetes and their unborn children face additional risks because of diabetes, these can be kept to a minimum through careful blood glucose management, before and during pregnancy, and intensive obstetrical care. For this reason, all women with diabetes need to plan ahead before becoming pregnant.

Before You Become Pregnant
When you decide to start a family, the first step is to meet with your health care team to consider the specific challenges you face. You may be concerned that your baby could develop diabetes. You may be worried for your own health. It’s important to get a good idea of how much extra work and expense may be involved before you become pregnant. Your glucose levels may also be an issue: The mother’s blood glucose is directly related to the risks to the growing baby. You also need a complete evaluation of your overall health and to check for any complications from diabetes. Because your diabetes management may change, meeting with a dietitian or diabetes educator will help.

Genetics. Whether you are a potential mother or father with diabetes, you may have concerns about your child someday developing diabetes. The best time to assess the genetic risk of your child developing diabetes is before pregnancy.

Type 1 diabetes is caused by an autoimmune attack on the pancreas that destroys the insulin-producing cells. A child born to a parent who has type 1 diabetes is at slightly greater risk of developing type 1 diabetes than children of parents without diabetes. The risk is slightly higher when the father has type 1 diabetes. Researchers have identified genes that could play a role in type 1 diabetes. But it is not yet clear what percentage of children who inherit a “diabetes” gene go on to develop diabetes or what environmental factors are also involved.

If a baby is born to a mother who is age 25 or older and has type 1 diabetes, that baby has a 1 percent risk of developing diabetes. If the mother is younger than age 25 at the time the child is born, the risk increases to about 4 percent. If the father has type 1 diabetes, the risk for the child of developing diabetes is about 6 percent. Each of these risks is doubled if the parent with type 1 diabetes developed it before the age of 11. If both parents have type 1 diabetes, the risk is not known but is probably somewhat higher. A child born to parents who do not have diabetes has a 0.3 percent risk of developing the disease.

Development of type 2 diabetes seems to depend on both genetic and lifestyle factors. Type 2 diabetes tends to run in families. Research on families with type 2 diabetes shows that you can inherit genes that increase your tendency to develop type 2 diabetes. Studies of twins have shown that genetics play a very strong role in whether a person develops diabetes, especially type 2 diabetes. Obesity also tends to run in families, and families tend to have similar eating and exercise habits.

“My sister with diabetes had a baby, and it nearly killed her. It’s just not a safe thing to do.”

Women with diabetes can and do have healthy babies
all the time. It doesn’t cost them their lives or health,
either. The survival rate for pregnancy is no different
between women with and without diabetes, as long
as the woman with diabetes takes care to practice
tight blood glucose management and treats any diabetes compli-
cations before becoming pregnant. And chances are excellent
that her baby will be just as healthy as a baby born to a mother
without diabetes.

But there are risks. High glucose levels early in pregnancy may
cause miscarriage or improperly formed organs in the baby. High
glucose levels later in the pregnancy put the mother at risk for
hypertension and preterm labor as well as possible worsening of
any diabetes complications. High blood glucose levels later in
pregnancy can cause the baby to grow too large and cause prob-
lems with delivery.

Pregnancy puts stress on any woman’s body. This is why it is so
important that you and your health care team keep a close watch
on your health before and throughout your pregnancy. But here’s
the good news: When women with type 1 diabetes who have
been pregnant are compared to women with type 1 diabetes who
have never been pregnant, about the same number of women in
each group show signs of diabetes complications. Being pregnant
doesn’t seem to raise your risk for complications over your life-
time.

With newer insulins, self-monitoring of blood glucose levels, and
improved techniques for early detection and treatment of compli-
cations, women with diabetes have entered an era of expanded
possibilities. Don’t let old-fashioned thinking stop you from work-
ing toward having a healthy baby.

If you have a family history of type 2 diabetes, it may be difficult to figure out whether your diabetes is due to lifestyle factors or genetic susceptibility. Most likely it is due to both. But just because you may have a tendency toward developing type 2 diabetes does not mean that insulin resistance cannot be prevented or reversed. In a large national study called the Diabetes Prevention Program (DPP),  participants who lost a modest amount of weight (5–10% of total weight) and participated in a moderate amount of exercise (150 minutes of walking per week) were able to delay or prevent type 2 diabetes even in the face of genetic susceptibility.

If you are concerned or have questions about the likelihood of having a child with either type 1 or type 2 diabetes, ask your provider to refer you to a medical geneticist or genetic counselor.

They are trained to assess the contributions of genetic and environmental factors in causing many diseases, including diabetes.

They will know the results of the latest diabetes and genetics studies and studies to prevent diabetes in high-risk individuals.