When you have diabetes, your body has problems making or using insulin. Insulin is a hormone that controls blood sugar levels. If you are diabetic, you may already be taking insulin or other diabetes medication to help regulate your blood sugar levels.

During pregnancy, the placenta produces a few hormones that also affect how insulin works. So, if you already have diabetes, pregnancy can make your sugar levels harder to control. The hormonal changes during pregnancy can also cause diabetes; this is called gestational diabetes and typically resolves after delivery. Because of this risk, all women are tested for diabetes during pregnancy, typically around 24 weeks gestation.

When you experience high (hyperglycemia) or low (hypoglycemia) blood sugars, so does the fetus in your uterus. So, if diabetes during pregnancy is not well controlled, it can cause serious complications during pregnancy and delivery, including – very rarely – fetal death. You should be aware that problems include:

• Birth defects, such as heart defects, kidney problems, gastrointestinal problems and spinal defects.
• A very big baby, making vaginal delivery difficult and possibly making a Cesarean delivery necessary.
• Neonatal low blood sugar, caused by the sudden drop in the baby's insulin levels after delivery.
• Respiratory distress at birth, caused by slower lung development.
• Increased risk of pre-eclampsia, a condition characterized by high blood pressure and risk of seizures and possibly requiring early delivery.
• Increased risk of urinary tract infections, which if untreated, can spread to the kidneys, causing harm to the mother and fetus.
• Too much amniotic fluid (called hydramnios), which can cause preterm labor (labor before 37 weeks).

Women with a history of diabetes may have some pre-pregnancy complications that may progress, increase complications or affect the fetus during pregnancy. Diabetic kidney disease (called nephropathy), eye involvement (retinopathy) and coronary artery disease (heart vessel blockage) require particular attention before and during pregnancy to ensure a healthy delivery. In rare cases, such as if the woman has severe coronary artery involvement, pregnancy may be too risky for her, as she is at high risk for a heart attack.

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