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Objective: Pregnancy without preparation in people with diabetes (PWD) can lead to adverse maternal and fetal outcomes. Improved patient knowledge through effective preconception counseling can help reduce the rate of complications. We developed a quality improvement initiative to improve both patient and provider knowledge. Methods: Interventions were implemented for PWD and providers (HCPs) at 2 underserved clinics. HCPs completed pre-intervention questionnaires (highest score of 10) about management of diabetes in pregnancy and preconception goals followed by a training lecture. PWD aged 18-50 with reproductive potential were identified to receive a survey (highest score of 6) about preconception preparation, contraceptive use, glycemic targets, and safer medications in pregnancy. HCPs used a standardized template to guide counseling during visit. PWD and HCPs completed a follow up survey 3- 6 months later. Results: Pre-intervention surveys were completed by 75 PWD and 16 HCPs. Documentation of preconception counseling by HCPs increased from 38% to 83% post intervention. Counseling was perceived as satisfactory by 83% of PWD. Conclusion: Process measures have improved with our pregnancy focused QI initiative. Continued enrollment and post-intervention assessment as well as expansion to include adolescent PWD will enable us to further evaluate outcome measures. Disclosure R. Fallurin: None. C. J. Levy: Advisory Panel; Dexcom, Inc., Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc., T1D Exchange. M. Rouviere: None. G. O'malley: Research Support; Dexcom, Inc., Abbott Diabetes, Tandem Diabetes Care, Inc., Omnipod, Eli Lilly and Company. S. Rodriguez ortega: None. A. W. Wang: None. S. J. Ogyaadu: None. C. Levister: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc., Abbott Diabetes. D. W. Lam: None. N. Shah: Research Support; Dexcom, Inc.

Background: Preconception planning can reduce complications in pregnancy with type 1 diabetes. However, high periconception HbA1C is not uncommon and increases maternal and fetal risks. Due to limited data regarding preconception counseling, questions about education and contraception use were added to the 2022 T1DX-QI survey. Methods: The annual T1DX-QI survey was conducted August-September 2022 with a site response rate of 94% of 50 sites: 33 pediatric (66%), 17 adult (34%). Respondents answered questions relating to clinic resources and practices. Response data was cleaned and summarized. Results: Most sites report discussing contraception (74%) and pregnancy planning (72%) once a year or more. Of pediatric sites, 42% report always asking about menstruation history compared to 6% of adult sites. Only 12% of adult and 6% of pediatric sites have a formal preconception counseling protocol. Only 12% of adult and 9% of pediatric sites estimated that >80% of their patients of childbearing potential were using contraception, and all sites estimated that <60% had a HbA1C under 7%. Conclusions: Though most sites report discussing contraception and pregnancy planning, estimated rates of formal counseling programs, contraception use and attaining goal HbA1C remain low. QI efforts are needed to determine rates of preconception counseling and implement best practices to improve pregnancy outcomes. Disclosure G.O'malley: Research Support; Dexcom, Inc., Abbott Diabetes, Tandem Diabetes Care, Inc., Omnipod, Eli Lilly and Company. M.Basina: None. R.Fallurin: None. C.J.Levy: Advisory Panel; Dexcom, Inc., Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc., T1D Exchange. T1dx-qi collaborative: n/a. S.J.Ogyaadu: None. C.Levister: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc., Abbott Diabetes. N.Rioles: None. H.Hardison: None. A.J.Roberts: None. S.Accacha: None. I.Guttmann-bauman: None. F.Vendrame: Consultant; Eli Lilly and Company. Funding The Leona M. and Harry B. Helmsley Charitable Trust