Women with Type 1 and Type 2 Diabetes entering pregnancy have more adverse pregnancy outcomes when compared with background populations around the world. Women with established diabetes start pregnancy with an increased disease burden both from diabetes but also from other medical conditions. This will be highlighted through baseline data from the EVOLVE study, a pan European registry of pregnant women with pre gestational diabetes and also from national audits in Ireland and the UK. The impact of pre pregnancy care (PPC) on pregnancy outcomes and its importance will be highlighted. The EXPECT trial examining the newer long acting insulin Tresiba compared to current Levemir in conjunction with Novorapid on further improving pregnancy outcomes will be discussed as will the benefits of CGMS as shown in the CONCEPTT trial. The importance of blood pressure control and targets for blood pressure for reducing rates of PET and pre term delivery will be shared as well as the impact of Aspirin on these outcomes.