Why does the United Kingdom remain so far from achieving the aim of “a pregnancy outcome for women with diabetes that equates with that of women without diabetes,” an aim outlined at the landmark St Vincent meeting of diabetes experts, government representatives, and patient organisations nearly 20 years ago?1 Pregnancy outcomes in the UK continue to be substantially worse for women with pre-existing diabetes (both type 1 and type 2), with rates of congenital anomalies and perinatal mortality significantly higher than in non-diabetic women and with care regularly falling short of the required standard.2 Many of the recommendations in the new guidelines from the National Institute for Health and Clinical Excellence (NICE) seem sensible and will be of use to all healthcare professionals in this area, but in places they are surprisingly clear cut given the relative paucity of high quality evidence.

The guidelines …