Despite clinical guidelines and widespread agreement about the importance of pre-pregnancy care, preparation for pregnancy remains suboptimal. The UK National Pregnancy in Diabetes (NPID) audit collected data on 2,537 diabetes pregnancies in women who delivered during 2014, incorporating 1193 women with type 1 (52%) and 1069 women (47%) with type 2 diabetes. Women with type 2 diabetes were older (34 vs 30 years) and more likely to have had two or more previous pregnancies (47% vs 28%). Only 15% women with type 1 and 36% with type 2 diabetes achieved target HbA1c level (<48mmol/mol or 6.5%) in early pregnancy. Women with type 1 diabetes were better prepared for pregnancy; 51% took preconception folic acid (400mcg or 5mg) compared to 33% type 2 diabetes. 10% women with type 2 diabetes were taking potentially harmful medications at conception (9% oral hypoglycaemic agents, 11% statins/ACE inhibitor/ARB). Changes are required in the provision of contraception advice and pre-pregnancy care, to focus more on reproductive health and safe effective contraception. For women “planning” pregnancy more equitable service design particularly for socially disadvantaged women with type 2 diabetes is urgently required.