Every woman starts out her pregnancy with a 3% to 5% chance of having a baby with a birth defect but uncontrolled diabetes increases that risk. Diabetes is one of the most common risks for birth defects. Women with diabetes should work with their provider to control their diabetes before they get pregnant. Mom’s provider will test her Hemoglobin A1C to see if it is within the normal range. Keeping the A1C in the normal range during the pregnancy will reduce the risks.

What are the risks?

Some of the birth defects associated with uncontrolled diabetes include birth defects in the spine, heart, bones, urinary tract, reproductive tract, and digestive system. Other risks include greater risk for miscarriage, stillbirth, pre-eclampsia, and polyhydramanios (too much fluid around the baby). At birth, babies born to moms with diabetes are at greater risk for being large (sometimes over 10 pounds), having breathing difficulties, jaundice, and low blood sugar. Not every woman with uncontrolled diabetes will have a baby with a birth defect but the risk increases from that baseline of about 5% to about 20% for very poorly controlled diabetes. During pregnancy, the doctor may recommend different tests, such as an ultrasound and echocardiogram to look at the heart, to determine if the baby is developing properly.

How is diabetes controlled during pregnancy?

Insulin is commonly used to control diabetes during pregnancy and the insulin does not increase the risks for birth defects. Gestational diabetes usually develops later in pregnancy, after those structures like the heart are already formed, so there is less of a risk in pregnancy. But it still needs to be controlled well to prevent the other problems that baby could have at birth such as breathing problems. For breastfeeding, moms should also control their diabetes to help produce milk and to prevent hypoglycemia, low blood sugar, in the infant.

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