Pregnancy is considered risky for the 1.85 million U.S. women of childbearing age who have diabetes. But women with preexisting diabetes are almost as likely as women without the disorder to have a healthy baby—as long as their blood sugar levels remain normal before and throughout pregnancy.

Women with poorly controlled diabetes in the early weeks of pregnancy are two to four times more likely than women without diabetes to have a baby with a serious birth defect, such as a heart defect or a neural tube defect. They also have an increased risk of miscarriage and stillbirth as well as increased risk of having a very large baby (10 pounds or more), which makes vaginal delivery more difficult and puts the baby at risk for injuries during birth.

If you have diabetes and you want to have a baby, you should see your doctor before you plan to conceive and establish good blood sugar control. If you have good blood sugar control around the time of conception, your risk of having a baby with a birth defect is nearly the same as that of women without diabetes.

If you take oral medications to control your diabetes, you’ll need to use insulin instead, both before and during pregnancy, as these oral medications may cause birth defects. You should take a multivitamin. Your doctor also may increase your daily dosage of folic acid above the recommended 400 micrograms that all women planning pregnancy should take to help reduce the risk of birth defects.

You’ll need frequent prenatal visits to adjust your diet and insulin as pregnancy progresses, and you’ll need to check your blood sugar levels at home several times a day. To learn more, contact the American Diabetes Association at 1-800-DIABETES or www.diabetes.org.