Because of your diabetes, you'll have extra challenges to deal with during your pregnancy. But the most important challenge is keeping your blood sugar under tight control. With the help of your health care team, you can monitor your blood sugar and avoid complications as your pregnancy progresses.

Achieving and maintaining tight blood sugar control during your pregnancy is easier if you assemble a health care team that's familiar with diabetes. The American Diabetes Association (ADA) suggests your team include these members:

• Your diabetes specialist. He or she may be an endocrinologist who specializes in the treatment of people with diabetes, including women who are pregnant.
• An obstetrician. He or she ideally should have special training in handling high-risk pregnancies and pregnancies of women with diabetes.
• A pediatrician or neonatologist. A pediatrician specializes in the treatment of children. A neonatologist is a pediatrician who specializes in the care of sick babies. These doctors have the expertise to treat babies born to women with diabetes.
• A registered dietitian. He or she can help you better manage your blood sugar by helping you create a meal plan for use during and after your pregnancy.
• A diabetes educator. Typically a registered nurse with certification in diabetes health education, he or she can teach you how to achieve tight blood sugar control.

If you live in a small town or a rural area and don't have easy access to specialists, ask your doctor about his or her experience treating pregnant women with diabetes. Find out if he or she has access to a specialist at a nearby university or metropolitan area. Your doctor may have you visit a specialist once during your pregnancy and consult with him or her during your pregnancy as needed.

Here's What Can Happen As Your Pregnancy Progresses:

First trimester
During the first 10 to 12 weeks of your pregnancy, you'll meet with your obstetrician regularly, perhaps every one to two weeks. This is the time that your baby's organs are developing, so you want your blood sugar to be as close to normal as possible to prevent birth defects. Frequent blood sugar monitoring can help you do this. Because your body's need for insulin may drop slightly during this time, it's important to be alert to signs of low blood sugar.

If morning sickness makes you miserable, talk with your doctor about medication to treat nausea.

Second trimester
The second trimester is when you'll likely receive an ultrasound to check the health of your baby. Your doctor also will keep track of your weight gain. Over the course of your pregnancy, you should gain 15 to 30 pounds, depending on your weight before pregnancy. If you're obese when you get pregnant, work with your dietitian to limit your weight gain to about 15 to 25 pounds. If your weight is normal, your dietitian may tell you to limit your weight gain to 25 to 35 pounds.

If you take insulin, expect your insulin requirements to rise gradually to about week 20 and then accelerate dramatically. Hormones made by the placenta to help your baby grow block the effect of your insulin, so you'll need significantly more to compensate. At this stage of your pregnancy, it's also important to see an eye specialist. Damage to the small blood vessels in your eyes can progress during pregnancy.

Third trimester
During the final three months of your pregnancy, your doctor will monitor you carefully. He or she will check for complications that can occur during the late stage of any pregnancy, such as high blood pressure, swollen ankles from fluid buildup and kidney problems. Your doctor may also recommend that you have your eyes examined again to check for eye damage.

Because women with diabetes are more likely to give birth to babies who weigh more than 9 pounds, you may receive another ultrasound to assess the size and health of your baby. At this stage, any potential problem for you or your baby may prompt early delivery of the baby.