Becoming pregnant for the first time can be overwhelming for any woman, especially if that woman has diabetes. When my husband and I decided we were ready to have children, the first thing I did was make an appointment with my endocrinologist. Diagnosed when I was fourteen, I've had type 1 diabetes for twenty-four years. My doctor explained that I would need to be in tight control for three months before I could even think about babies, so I got right to work. Learning everything I could about diabetes and pregnancy, I was pleased to discover that with education, support, and practice, a woman with diabetes has every opportunity for a healthy pregnancy.

High-risk pregnancies like mine are becoming more common. According to a 2008 Kaiser Permanente study published in the May issue of Diabetes Care, more diabetic women than ever before are having babies. The study, the largest and most diverse to examine pre-pregnancy type 1 and type 2 diabetes, examined more than 175,000 women in California during a seven-year period. The researchers reported that "diabetes before motherhood has more than doubled in six years among teenage and adult women" and that there were "twice as many births to women with diabetes in 2005 as there were in 1999." The increase is probably due to the rise in obesity and type 2 diabetes in women at younger ages. The researchers did not distinguish between type 1 and type 2 diabetes, but noted that both types can pose risks to the developing baby when the diabetes is not well managed. The good news is that a healthy pregnancy is within reach for all women with diabetes.

In "The Diabetic Woman, All Your Questions Answered," Dr. Lois Jovanovic says, "It's so much easier to plan to have a baby by first getting your blood sugars as close to normal as possible, rather than having to play catch-up by manipulating insulin, diet, and exercise to quickly normalize blood sugars so your baby does not experience high blood sugars."

The planning stage is critical in a diabetic pregnancy because the baby's organs begin to develop immediately after conception. By the first time you miss your period, your baby's heart has already been formed. Six weeks after your last period, the time most women discover they are pregnant, the baby is forming a brain, and by eight weeks, the baby is completely formed.

So before you start thinking about pregnancy, ask yourself some important questions. Am I ready to become educated, seek support, and practice good health? If the answer is yes, here are suggestions and advice from experts on how to get started.

Educate Yourself

Preparing for a diabetic pregnancy is like preparing for a marathon. When Laura Bennett, a type 1 diabetic, mother of three, and pregnancy blogger for Diabetes Sisters, began training for her first marathon, she read everything she could to educate herself about distance running. Laura also found running partners for support, and she practiced hard, running a little farther each week until race day. When Laura decided to become pregnant, she said, "If I can complete a marathon, I can get through this pregnancy." Laura was in great physical shape and her blood sugars were in good control because of her running. However, "finding information on type 1 diabetes and pregnancy was difficult. Almost everything I came across was about gestational diabetes or type 2. Sometimes the information I did find was so discouraging and frightening that I thought maybe I shouldn't risk it and just adopt. Luckily, my endocrinologist was very supportive, and I found the most amazing OB."

The best way to get your blood sugars in the normal range before you become pregnant is to work with a healthcare team. Find a team of doctors that includes an endocrinologist, a nutritionist, a nurse-educator and an OB/GYN. Dr. Liz Stephens, mother and type 1 diabetic, cautions that it is critical to find a team of doctors and educators specific to your needs. "This is especially important with your obstetrician. Many are excellent with gestational diabetes but have limited experience with type 1, and the difference is huge!"

Women with diabetes should also get a clean bill of health before they become pregnant. Dr. Jill Mauldin, Associate Professor of Maternal Fetal Medicine at the Medical University of South Carolina, recommends getting preconception care that includes kidney and eye assessments. Dr. Mauldin says that "anything that is out of balance when you go into a pregnancy will cause the pregnancy to be rocky." In order to begin your pregnancy confident that your body is physically ready for the next nine months, seek education about the health of your body, head to toe.

Helpful Books:

• The Diabetic Woman, All Your Questions Answered. By Dr. Lois Jovanovic, June Biermann, and Barbara Toohey.
• Diabetes & Pregnancy, What to Expect. Your Guide to a Healthy Pregnancy and a Happy, Healthy Baby. By The American Diabetes Association.
• Women & Diabetes, Staying Healthy in Body, Mind, and Spirit. By Laurinda M. Poirier, MPH, RN, CDE, and Katharine M. Coburn, MPH.

Seek Support

Now that you have done all the work to prepare your body physically, it's time to focus on the emotional impact of a diabetic pregnancy. Brandy Barnes, MSW, founder of Diabetes Sisters, spent days, months, and even years planning for a "high-risk" pregnancy.

"I read books, got my A1c to a respectable level of 6.0, reduced my caffeine consumption, and interviewed high-risk obstetricians, virtually everything I could think of...Nonetheless, it was about three months into my pregnancy when I realized the critical component I had overlooked. I searched high and low for a woman with diabetes who had experienced pregnancy and could answer my questions or just tell me that what I was going through was normal, and I came up empty handed. Having support from a woman with diabetes would have allowed me to relax and enjoy my pregnancy so much more. I would have been able to focus on the really important things rather than spending time worrying about unnecessary fears."

Brandy's realization was the impetus behind the creation of Diabetes Sisters (www.diabetessisters.org), an international nonprofit organization dedicated to the needs of women with diabetes. Clemma Muller, mother, type 1 diabetic, and member of the Diabetic Moms Yahoo group, says, "Many women with diabetes would not be able to find an in-person support group with the size and depth of experience that the online community provides. I am certain I would have had a less positive experience with both pregnancies if it weren't for this group." Check out support groups on Yahoo such as: Positive Diabetic Pregnancies and Gestational Diabetes.

Practice Makes Perfect

Blood sugar control is a lifelong goal for everyone with diabetes, but tight control is particularly important during the planning stages of pregnancy. Dr. Mauldin says that women planning to become pregnant need to revise their blood sugar goals. What was acceptable before is not acceptable during pregnancy. I remember worrying when I was told that my fasting sugars needed to be between 70 and 90 because it seemed difficult to achieve. Dr. Mauldin acknowledges that this change is challenging and that patients need to be supported and guided by their doctors and OB/GYNs. During the time when I was getting ready to become pregnant with our first child, I set my alarm in the middle of the night to wake up and test my blood sugars. I also gave up caffeine and alcohol and became more vigilant about a balanced diet.

Exercise needs and ability change during pregnancy, but getting thirty minutes of exercise at least five times a week is more important than ever. Laura Bennett decreased the intensity of her runs before she became pregnant, but maintained a consistent, low-impact exercise routine to keep her blood sugars balanced. As always, it's important to talk to your doctor about exercise when you are planning a pregnancy.

When healthy eating becomes a habit in the planning stage, it will be easier to maintain during pregnancy. Dr. Liz Stephens recommends finding a nutritionist and/or diabetes educator who "can help with nutritional suggestions and get away from the standard pregnancy meal/snack/meal/snack that is so tricky with type 1 diabetes. Thinking outside the box is key!" Lyndsay Riffe, RD, CDE, LDN, (who is also a type 1 diabetic) says, "Women who desire to become pregnant and are overweight can benefit from weight loss prior to conceiving." Any changes to diet should be approved by a doctor. Lyndsay also recommends:

1. Focusing on high fiber foods (whole grains, fruits, vegetables, and beans), packing lunches and snacks from home to take to work, and avoiding carbohydrate overloading. Balance and consistency are tools to get your sugar under control.
2. Keeping your own personal glycemic index. If you know eating grapes makes your blood sugar spike, avoid grapes. Diabetes is not a one-size-fits-all lifestyle.
3. Meeting with a registered dietitian or RD-CDE. See www.eatright.org or www.diabeteseducators.org to find a local dietitian who can help you separate fact from fiction.

Diabetes and pregnancy have come a long way, and babies being born to women with diabetes are no longer the exception to the rule. As more and more women are diagnosed with diabetes in child-bearing years, the healthcare community needs to increase education and support. And instead of negative myths about risks and birth defects, maybe the language will now be in terms of education, support systems, and practice.