Table 1 Literature-review of pre-pregnancy programs

DVD [10, 13, 23, 24]

Northern Island/UK

The importance of planning pregnancy and the role of contraception.

A diabetes specialist- nurse and -midwife, a dietitian, a GP, a clinical health Psychologist, an obstetrician, a nutritionist

1 [10]: Two national health services

2 [13]:At their centre

3 [23]: Five diabetes care within the five health and social care trust and general practices;

4 [24]:

At their centre

1 [10]: The DVD significantly improved self-efficacy and reduced perceived barriers. Knowledge of pregnancy planning and pregnancy-related risks increased (P < 0.001).

2 [13]: The development process and outcome evaluation are an important point of reference for future educational programs

3 [23]: The viewed-DVD subgroup had lower first visit HbA1c (P < 0.001; increased planned pregnancy (P < 0.001); increased folic acid preconception (P = 0.001); and had improved HbA1c preconception (P < 0.001).

4 [24]: the development of an e-learning continuing professional development resource within the website.

EASIPOD^a [5, 9, 19]: websites, workshops for HCP,

Leaflets, structured audit with benchmarking, poster formal and informal patient education programs

East- Anglia/ UK

Planning a pregnancy and contact details for local PPC coordinator

Diabetes physician, specialist nurse, midwife or obstetrician

Primary-care teams in community settings, women with T1D: by specialist teams in hospital settings. Joint clinics.

5 [5]: Women with PPC presented earlier (P = 0.001), were more likely to take 5 mg preconception folic acid (P = 0.0001) and had lower HbA1c (P = 0.0001). They had fewer adverse pregnancy outcomes P = 0.009). Lack of PPC was independently associated with adverse outcome (OR = 0.2; 95% CI 0.05–0.89).

6 [9]: Understanding PPC (90%); optimal glycaemic control (80%); risks of malformation (48%) and macrosomia (35%). 70% were not regularly using contraception (70%), stopped deliberately (45%), become less rigorous (28%) or experienced side effects (14%).

EASIPOD 2^a [19]: websites, workshops for HCP,

Leaflets, structured audit with benchmarking, poster formal and informal patient education programs; GP software flags, online education program for HCPs

East- Anglia/UK

Planning a pregnancy and contact details for local PPC coordinator

Diabetes physician, specialist nurse, midwife or obstetrician

Primary-care teams in community settings, women with T1D: by specialist teams in hospital settings. Joint clinics.

7 [19]: In those withT1D: improved gestational age at booking (7.6 vs 8.4 weeks), and in women with T2D: high rate of first HbA1c of < 6.5% < 48 mmol (58.5% vs 44.4%) and higher rate of preconception 5 mg folic acid (41.8% vs 23.5%)

READY-Girls

[12, 20, 21]

Pittsburgh/USA

Presents the effects of diabetes on reproductive health, puberty, sexuality, and pregnancy and the benefits of PPC and includes skill-building exercises for healthy decision making and communication with HCPs.

Specialised nurses and GPs

Major university-based diabetes clinics

8 [20]: Improved knowledge about family planning and reproductive health issues.

9 [12]: Increased in knowledge after the first visit (P < 0.001) and being sustained for 9 months (P < 0.05). preconception counselling barriers decreased over time (P < 0.001), and intention and initiation of preconception counselling and reproductive health discussions increased (P < 0.001).

10 [21]: Stronger knowledge about PPC (P = 0.003) and seek PPC when planning a pregnancy\ (P = 0.02)

Leaflets and posters in out-patient waiting room [22]

Ireland

Patient education, a full medication review, assessment & treatment of diabetes-complications and thyroid status, commencement of folic acid 5 mg/d and focus on intensive glucose monitoring

Specialist and general practitioners

Antenatal care by Primary care clinicians, local endocrinologist, diabetes nurse specialist and dietitian

Attendees were more likely to take preconception folic acid (P < 0.001) and less likely to smoke (P = .03). Attendees had lower glycated haemoglobin levels (P < .001; third trimester HbA1c (P = 0.001), and their offspring had lower rates of serious adverse outcomes (P = 0.007)