Managing diabetes early—even before conception—is vital for the health of both mother and baby, as uncontrolled blood sugar can lead to serious health risks.

Casey Vlach, BSN, RN, CDCES, CPT, is a Certified Diabetes Care and Education Specialist and Diabetes Clinical Program Coordinator who has experienced this firsthand. During her first pregnancy, she received a borderline glucose screening result, which required additional testing to confirm she did not have gestational diabetes. 

However, during her second pregnancy at age 40, Casey was diagnosed with gestational diabetes, which required her to get insulin and deliver early. Her experience underscores the importance of proactive diabetes management and preconception care. 

As a healthcare professional and a mother, Casey is dedicated to supporting women—especially those with risk factors like advanced maternal age, family history of diabetes or being overweight—in managing diabetes effectively and reducing pregnancy risks.

Why preconception care matters

A baby’s organs develop early in pregnancy, between weeks five and eight, so it’s important to have your blood sugar under control before conception. Working with your healthcare team to manage your blood sugar and maintain a healthy lifestyle is essential for reducing risks and ensuring a healthy pregnancy. 

Preconception care can lower the chances of:

• Birth defects or congenital malformations
• Preterm delivery
• NICU admission
• Pregnancy loss
• Low birth weight

Preconception planning should be a regular part of diabetes care. Talking with your healthcare team prior to conception gives you the knowledge and resources you need to prepare for a safe and healthy pregnancy.

How to manage your diabetes before pregnancy

Whether you have type 1 or type 2 diabetes, or had gestational diabetes during a previous pregnancy, here’s how you can prepare for a healthy pregnancy:

1. Get your blood sugar under control – The most important step is managing your blood sugar. Aim for an A1C of less than 6.5% to reduce the risks of complications like birth defects and preterm birth. Work closely with your doctor to monitor and manage your blood sugar levels effectively.
2. Talk to your doctor – Schedule a preconception appointment. Your doctor can help you determine whether your current diabetes treatment plan is appropriate for pregnancy. This includes reviewing your lifestyle choices and medications, as some may need to be adjusted to ensure a safe pregnancy.
3. Meet with an endocrinologist – Consider consulting with a doctor who specializes in managing diabetes. They can help stabilize your blood sugar levels and address other issues like thyroid imbalances.
4. Maintain a healthy weight – Maintaining a healthy weight helps regulate blood sugar and reduces pregnancy risks. Consult your doctor for weight management advice.
5. Eat a healthy diet – A nutrient-rich diet is essential for managing diabetes. Focus on whole, unprocessed foods like fruits, vegetables, lean proteins and whole grains. A dietitian can help create a personalized meal plan tailored to your needs.
6. Exercise regularly – Aim for at least 30 minutes of moderate activity most days. Regular exercise helps control blood sugar and support overall health.
7. Stop smoking – Smoking increases the risk of birth defects and preterm birth. Quitting smoking improves your health and increases your chances of a healthier pregnancy.
8. Avoid alcohol – It's important to avoid alcohol when planning to conceive and throughout pregnancy. Drinking alcohol can interfere with your blood sugar and increase the risk of complications. 
9. Take a prenatal vitamin – Start taking a prenatal vitamin with folic acid before conception. Folic acid helps prevent birth defects and supports overall health. Talk to your doctor about the right vitamin and dosage for you.
10. Manage stress – Stress affects blood sugar, so take steps to manage it. Speak to your doctor if you need emotional support or therapy.