There is good evidence that pre-pregnancy counselling (PPC) among women with type 1 and type 2 diabetes is associated with better pregnancy outcomes. However, implementation of PPC remains patchy. The aim of this project was to assess current practice in pregnancy management and pregnancy outcomes for women with type 1 and type 2 diabetes and to gather local recommendations for improving access to PPC. A retrospective cohort study of 96 pregnancies of women aged 16 to 45 with type 1 and type 2 diabetes between 2011 to 2015 in the Macarthur District was performed. Management during pregnancy were compared with ADIPS guidelines, including HbA1c, folate and teratogenic medication use and retinal screening. Pregnancy outcomes observed included delivery method, congenital malformations, and neonatal complications. Discussions with health care professionals were conducted to explore their knowledge, management and opinions on PPC. The mean pre-pregnancy HbA1c (7.7±2.7%, n=66) exceeded ADIPS recommendations. Where recorded, 44% took no folic acid, ACEI/ARBs, statins and sitagliptin/exenatide/gliclazide were taken by 3%, 2% and 3% respectively. 33% of women had no retinal screening. Major/minor congenital malformations occurred in 5%/4% pregnancies respectively. 57% pregnancies involved jaundice, hypoglycaemia, shoulder dystocia and/or other complication. Only 30% of births occurred through normal, non-induced vaginal births with 21%/31% involving elective and emergency caesarean sections. Discussions with local health professionals revealed a general consensus regarding the need for establishing and improving awareness of PPC in the area. They suggested increased sex-education and pre-pregnancy advice, establishment of after-hours clinics or including a diabetes specialist in after-hours antenatal clinics. Online or telephone consultations were also proposed. Another suggestion was to increase funding to train and employ more staff skilled in PPC. We conclude that lack of PPC remains an issue in this area and a systematic approach to PPC is recommended.