Background and Objectives: Pre-existing diabetes is associated with poor pregnancy outcomes, yet much is unknown about knowledge of preconception care among diabetic women. The objective of this study was to examine the knowledge and preconception care seeking practices of diabetic women in the reproductive age. Methods: A cross- sectional hospital based study of 114 diabetic women between 15-45 years old was conducted between March and May 2017. Data was collected using structured questionnaires in face to face interviews. Chi- square test was used to determine the association between knowledge levels and identified factors; these were further analyzed using binary logistic regression to determine the adjusted odds of poor knowledge. Results: The findings showed that 52.6% of diabetic women that participated in our study had poor knowledge of preconception care. Independent factors associated with poor knowledge on preconception care were up to primary level of education [AOR 4.54, 95% CI (2.23, 9.27)] and ?1 year duration of diabetes diagnosis [AOR 3.21 95% (1.35, 7.65)]. About 67% of the participants with a history of being pregnant after diagnosis of diabetes did not seek pre-conception care. Conclusions and Implications for Translation: The study indicated poor knowledge level as well as poor practice of seeking preconception care. There is need to explore the establishment of clinical guidelines and policies that will allow the dissemination of pregnancy related advise to diabetic women. Key words: • Diabetes Mellitus • Diabetic Women. • Preconception Care • Reproductive Age Group • Knowledge • Practice • Zambia   Copyright © 2017 Mutale et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.