Preconception care is key to improving the outcome of diabetic pregnancy. Despite evidence showing that preconception care reduces congenital malformation in the offspring of diabetic mothers, most women do not plan their pregnancies with their diabetes team. Issues around managing this complex behaviour include the quality of the relationship with health care providers and the woman's health care beliefs. The elements of good preconception care have recently been defined, but there are problems around access to preconception services. There is a small number of preconception services within England, Wales and Northern Ireland; provision of these services needs to be increased if the goal set by the NSF for diabetes is to be achieved.