Findings Indicate Structured Preconception Care May Decrease Perinatal Mortality in Diabetes

How much does optimizing diabetes care before conception change pregnancy outcomes? With pre-existing diabetes on the rise among women of reproductive age, new evidence from a systematic review in BMC Pregnancy and Childbirth highlights the critical value—and persistent gaps—of pre-pregnancy care (PPC).

Study Design: What Did the Review Assess?

This systematic review evaluated 51 studies comparing women with type 1 or type 2 diabetes who received structured pre-pregnancy care with those who did not. PPC was broadly defined, but typically included glycemic optimization, folic acid supplementation, medication review, and pregnancy planning. Outcomes analyzed included glycemic control (HbA1c), congenital malformations, perinatal mortality, gestational age at booking, and other maternal and neonatal endpoints.

Main Findings: Early Glycemic Benefits and Fetal Protection

Consistent reduction in first-trimester HbA1c was observed, with PPC groups typically 0.6–1.0 percentage points lower than non-attendees.

The effect on glycemic control later in pregnancy was less robust, likely reflecting increased intensity of routine care after conception.

Congenital malformations and perinatal mortality were generally lower in PPC groups, especially in type 1 diabetes, though results varied and were often limited by sample size or incomplete adjustment for confounding factors.

Earlier antenatal booking (by 1–4 weeks) was facilitated by PPC, potentially enabling more timely risk assessment and management.

Other Outcomes: Mixed Evidence and Limitations

Effects on miscarriage, preeclampsia, cesarean delivery, birthweight, and neonatal complications were inconsistent across studies.

Only a handful of studies focused exclusively on type 2 diabetes, underscoring a major evidence gap as this population grows.

Studies that defined PPC as a comprehensive, multidisciplinary intervention generally reported stronger benefits than those that looked only at pregnancy planning or retrospective classification.

Clinical Implications: Why This Matters for Practice

Structured pre-pregnancy care remains crucial for women with pre-existing diabetes—especially for optimizing periconceptional glycemic control and reducing the risk of congenital anomalies and perinatal death.

For type 2 diabetes, there is an urgent need to develop, implement, and study effective PPC strategies, as most evidence is extrapolated from type 1 diabetes populations.

Integrating PPC into routine diabetes care, ensuring equitable access, and targeting modifiable risk factors (e.g., glycemic control, medication use, folic acid, comorbidity management) are key for improving outcomes.

Conclusion

Despite advancements in diabetes technology and clinical care, pre-pregnancy care remains a cornerstone for reducing risk in women with diabetes. Early engagement, multidisciplinary support, and structured interventions can make a measurable difference—for both mothers and infants.

Key points

Pre-pregnancy care in women with diabetes consistently reduces first-trimester HbA1c.

Congenital malformations and perinatal mortality are generally lower with structured PPC, especially in type 1 diabetes.

Evidence for women with type 2 diabetes remains limited and highlights a need for focused research and intervention.

Pre-pregnancy care leads to earlier antenatal booking, improving early risk management.

Comprehensive, multidisciplinary PPC programs yield the strongest benefits for mother and baby.

Citation:

Knudsen TS, Hansen LS, Kampmann U, et al. Effects of pre-pregnancy care for women with type 1 or type 2 diabetes: a systematic review. BMC Pregnancy and Childbirth. 2026. https://doi.org/10.1186/s12884-026-09808-5