## Before pregnancy The most important thing a woman with [diabetes](https://ul.orna.me/KOge/librarydisease?id=43) should understand is that her pregnancy is special. First of all, at least three months before conception, compensation for diabetes should be achieved, as the child's health is affected not by the disease itself, but by blood sugar spikes. ## During pregnancy A woman with diabetes should be monitored from the first days of pregnancy. A team of doctors will be needed to monitor for all nine months. These include an endocrinologist, an obstetrician-gynecologist who specializes in helping [pregnant](https://ul.orna.me/KOge/librarydisease?id=3) women with diabetes, a nutritionist, and a therapist. Their task is to maintain a normal glycemic state, prevent the development of complications, and stabilize issues that already exist. Just as important is constant monitoring: ===measuring blood pressure, consultation with an ophthalmologist, evaluation of the [thyroid](https://ul.orna.me/KOge/librarydisease?id=44) gland and tests for [TSH](https://ul.orna.me/KOge/librarybiomarker?id=137), T4-related and T3-related, consultation with a neurologist, checking kidney function, the exclusion of urinary tract infections, ECG and, of course, monitoring of the fetus. Much depends on the pregnant woman's self-monitoring as well. She will have to check sugar levels more often and stick to strict [glycemic](https://ul.orna.me/KOge/librarybiomarker?id=110) parameters: - 3.5–6.1 mmol/l on an empty stomach - 5.0–7.8 mmol/l after meals It is also necessary to control the level of ketones in the urine, which can suddenly rise sharply during a common cold or a long break in food intake. In order not to miss dangerous changes in parameters, you should fill out a self-monitoring diary, where you should note the dose and time of insulin administration, the results of glycemic measurements, and tests for ketonuria. The diary should always be taken with you during doctor's visits. Even patients with type 2 diabetes who take tablet antidiabetic drugs should switch to insulin injections during pregnancy and breastfeeding, as pills harm the fetus. In early pregnancy, the sensitivity to insulin increases, and from the 12th week it decreases and the dose has to be adjusted. It is necessary to discuss with the doctor how the fetus is affected by drugs that the woman took for complications of diabetes. It is also important to discuss the possibility of replacing them with other medications. For diet, women should eat about 1,800 calories per day during the first trimester, and 2,200 calories per day during the second and third trimesters. Protein should make up at least 15 % of the diet, fat should make up 30 %, complex carbohydrates should make up 55 %. > Pregnancy is contraindicated only in cases of severe diabetic neuropathy, severe coronary artery disease, and progressive proliferative retinopathy. ## During childbirth and after the baby is born Pregnant women with diabetes are typically hospitalized at 35–36 weeks of pregnancy. At this time, both the mother and the fetus should be monitored more closely. If the size and position of the fetus are normal, normal physiological delivery is possible. C-section requires special indications. Diabetes mellitus is not a contraindication for breastfeeding — however, self-monitoring must remain high, as there is a risk of severe hypoglycemia. Self-monitoring skills instilled during pregnancy will help maintain health for years to come and ensure healthy children.