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We recently undertook a multi-centre study of diabetic pregnancy [1] and were struck by the lack of pre-conception planning (40% only) despite all centres having a specific interest in the management of diabetic pregnancy and the service being freely available. We therefore planned a survey of attitudes to and knowledge of maternal diabetes relating to pregnancy.Sixty-nine randomly selected women of childbearing age (16 -45 years) attending a general diabetic clinic completed a questionnaire. Local Research Ethics Committee approval was obtained.Questions were designed to assess the knowledge of diabetes in pregnancy in the following categories: necessity for good glycaemic control before conception and during pregnancy, effect of diabetes on the fetus, importance of pre-pregnancy counselling, parity, attendance at pre-pregnancy clinic in their past pregnancy, and whether they sought specific information on diabetic care before planning pregnancy.Of the 69 diabetic women, 18 were multiparous and rest were nulligravid. A large majority of women (85%) reported that they knew their diabetes could affect the health of their baby and good diabetic control was important at the time of conception.Sixty-nine percent of nulligravidae compared with 83% of multiparae were aware of the need for preconception planning. The source of this information was equally divided between doctors (33%), other clinic staff (33%) and leaflets / handouts (32%). Conspicuously unusual among reported sources was 'diabetes association' (4.5%).Of the 18 multiparous women, only eight (44%) had attended for pre-pregnancy counselling prior to their last pregnancy.Only 52% of nulligravidae, and 28% of multiparae reported the intention to seek advice before a future pregnancy.It is generally accepted that meticulous diabetes management can reduce perinatal morbidity and mortality. The acceptance rate of preconception advice in our questionnaire survey closely resembles that observed in our pregnancy survey [1], suggesting that this was a representative group of women.It is worrisome that although there is a large awareness of need amongst these women, translating this into action does not seem to happen. Among the possible reasons may be lack of faith in the service, ignorance of access routes, or simply inertia. It is clear, however, that although knowledge of the importance of pre-pregnancy counselling is high, this does not translate itself into action, and multiparae were less likely to indicate that they would attend for pre-pregnancy counselling in the future.Teaching and knowledge do not necessarily change behaviour, and it seems clear that a novel approach to this topic is needed if outcomes are to be improved for pregnancies complicated by maternal diabetes, and this input should continue throughout a diabetic woman's reproductive life. Reference1 Masson EA, Patmore J, Brash PD, Baxter M, Caldwell G, Gallen I et al. Perinatal outcome in type 1 diabetic pregnancy treated with insulin Lispro. Diabet Med 2001; 18 (Suppl. 2): 53.