Before she became pregnant, Molly Duerr never understood why expectant moms would say they didn't care if it were a boy or a girl, only that the baby be healthy.

"I thought, 'Of course you'd want to know what the baby's going to be,' " says Duerr, 30, who has type 1 diabetes. But after becoming pregnant last year and realizing all the health risks associated with diabetes, she says, "I got it."

A growing number of women, like Duerr, are either heading into pregnancy with diabetes — type 1 and type 2 — or developing gestational diabetes while pregnant, says endocrinologist Sue Kirkman, vice president of clinical affairs for the American Diabetes Association. Kirkman says diabetes raises the risk of miscarriages, delivery complications, maternal health problems and birth defects, but she adds that the risks can be slashed with pre-conception counseling, tight control of blood sugar and maintaining a healthy weight before and during pregnancy.

"There are many concerns women with diabetes grapple with, everything from childbearing worries and premature cardiovascular disease to greater financial burdens," says Ann Albright, director of Diabetes Translation at the Centers for Disease Control and Prevention.

Women who go into pregnancy already diagnosed with diabetes have what's called pre-gestational diabetes. Diabetes that develops during pregnancy is referred to as gestational diabetes.

Almost five out of every 1,000 women ages 18 to 44 have diabetes, according to the CDC. Most have type 2 diabetes, which is linked to obesity.

Gestational diabetes, which typically is tested for around the 28th week of pregnancy, occurs in about 4 percent of patients, says Helain Landy, chairwoman of the department of obstetrics and gynecology at Georgetown University Hospital. "From an epidemiological standpoint, that is a lot," Landy says.

Diabetes during pregnancy can cause high blood levels of glucose, which can lead to health problems in mothers and babies alike. When extra sugar in the mother's blood crosses the placenta to the fetus, a baby can have organ malformation (in mothers with pre-existing diabetes) and grow too large, leading to delivery complications.

For women with existing diabetes, pre-conception counseling is paramount to a healthy pregnancy and baby and should begin when girls with diabetes are as young as 13, says Denise Charron-Prochownik, associate professor of health promotion and development at the UPMC School of Nursing and Graduate School of Public Health. "But it's not happening," she says.

Though Duerr and her husband sought out medical advice about six months before she conceived, Kirkman says surveys suggest only about half do the same.

With gestational diabetes, Kirkman says, the key is to keep weight and blood sugar under control with a healthy diet, exercise and sometimes insulin.

It's not easy, Charron-Prochownik says. "Women have to be very motivated."

Florence Brown, co-director of the Joslin Beth Israel Deaconess Medical Center's Diabetes and Pregnancy Program in Boston, is studying cardiovascular risks in women who had gestational diabetes. She says many do not realize they are more likely to develop cardiovascular disease or their baby has a greater chance of developing diabetes later in life.

To help lower the risk of similar pregnancies and health risks, next month the ADA and the American College of Obstetricians and Gynecologists plan to launch a joint awareness campaign that targets women during and after pregnancy.