The US Centers for Disease Control and Prevention reports that women who develop diabetes before they become pregnant are three to four times more likely to give birth to a baby with at least one birth defect.

The study, published in the American Journal of Obstetrics and Gynecology was the result of a thorough analysis of birth records between 1997 and 2003 at hospitals in 10 states Arkansas, California, Georgia, Iowa, Massachusetts, New Jersey, New York, North Carolina, Texas and Utah. The children were participants in the National Birth Defects Prevention Study.

“This study documents the fact that diabetes is associated with a wider range of defects that we had been aware of in the past,” said Dr, Adolfo Correa, MD, MPH, PhD, the study’s lead author and an epidemiologist at the CDC’s National Center on Birth Defects and Developmental Disabilities.

The analysis focused on 13,030 babies born with birth defects and 4,895 babies without birth defects. The researchers determined which mothers had diabetes before becoming pregnant or while being pregnant. Some 24 mothers of the nearly 5,000 infants without birth defects had diabetes before pregnancy and 283 mothers of the babies with birth defects had diabetes before pregnancy.

Women with diabetes had triple the risk of having a baby with birth defects compared to other women, the study found.

Birth defects discovered by the analysis included defects of the heart, brain, spine, limbs, kidneys and gastrointestinal tract, penile and ear abnormalities and cleft palate.

According to the findings, it seems that a form of diabetes, which appears in a woman during pregnancy (gestational diabetes), is not associated with an increased risk of birth defects unless the woman’s pre-pregnancy BMI had been 25 or higher. In gestational diabetes, a woman’s blood sugar levels return to normal once the baby is born.

Given the results of the study, Correa urged for early and effective management of diabetes for pregnant women in order to avoid not only birth defects but also other health complications for them and their children.

The situation is the more serious as about 1.85 million US women of childbearing age have diabetes, according to a report of the March of Dimes.

“Given the increasing prevalence of diabetes, including diabetes among women of reproductive age in this country and in many parts of the world, this is a call to action to the clinical and public health communities to come up with more effective prevention measure,” Correa said.

One in 33 babies born in the US suffers a birth defect, which is the cause of one in five infant deaths. Causes of birth defects are not clear, but there are some risk factors including alcohol, smoking, obesity, and infections. With the new study, diabetes adds to the rest of the risk factors.

Therefore, women thinking about having a baby should lead a healthy lifestyle with lots of exercise and healthy food in order to prevent obesity, which can further lead to diabetes and other disease increasing the risk of birth defects.