Introduction 1 1 1 5 1 1 4 7 1 8 9 2 3 9 10 11 11 12 16 3 10 15 17 18 12 16 Greater awareness of the potential contribution of preconception care to diabetes prevention and control may help reduce the devastating impact of diabetes and its complications on the lives of women and their families. The objectives of this paper are to: 1) review barriers that can impede a woman’s ability to receive preconception care, and 2) recommend novel interventions to reach reproductive-aged women with or at risk for diabetes. 19 20 21 15 1 15 3 19 24 25 27 25 28 Barriers to receiving preconception care 15 28 29 25 28 1 28 30 31 32 34 32 34 15 32 34 35 15 32 34 36 25 26 28 33 35 16 32 36 Interventions to reach women of childbearing age with diabetes 28 28 27 28 Novel interventions to reach reproductive-aged women with or at risk of diabetes 37 38 The National Agenda for Public Health Action 39 1 National Agenda National Agenda 37 38 Table 1 The National Agenda’s 10 priority recommendations for action 1. Encourage and support diabetes prevention and control programs   in state health departments to develop prevention programs for all   women and establish efficient links for women at risk for type 2   diabetes 2. Expand community-based health promotion, education, activities,   and incentives for all ages in a wide variety of settings—schools,   workplaces, senior centers, churches, and other locations where   women live, learn, work, and play 3. Strengthen advocacy on behalf of women with or at risk for   diabetes 4. Fortify community programs for women with sufficient training,   tools, and materials 5. Expand population-based surveillance to monitor and understand:  a. Variations in the distribution of diagnosed and undiagnosed   diabetes  b. The factors—cultural, racial, ethnic, geographic, demographic,   socioeconomic, and genetic factors—that influence the risk for   diabetes and complications among women at all life stages 6. Educate community leaders about diabetes and its management   and about the value of healthy environments 7. Encourage healthcare providers to promote risk assessment,   quality care, and self-management for diabetes and it   complications in their practice settings 8. Ensure access to trained healthcare providers who offer quality   services consistent with established healthcare guidelines 9. Encourage healthcare coverage and incentives for recommended   diabetes prevention management practices by:  a. Promoting partnerships between insurers and workplaces or   labor communities and encouraging employers and employees to   discuss needed diabetes benefits in offered health care packages  b. Working with health insurers and policymakers to expand   coverage and reimbursement policies to include prevention   services for women throughout their lives 10. Conduct public health research to further our knowledge about   the epidemiological, socioenvironmental, behavioral,   translational, and biomedical factors that influence diabetes and   women’s health National Agenda’s Community intervention and the involvement of community health workers National Agenda 39 32 36 33 40 41 41 42 43 44 48 Community health workers could play a vital role in linking women to preconception care services in the following manner: 1) increasing women’s awareness about the importance of preconception care programs, 2) providing culturally and linguistically appropriate diabetes-related health information and education, 3) reminding women about scheduled health provider visits, 4) providing a communication bridge linking women and providers in terms of patients’ needs and providers’ recommendations. 4 8 18 49 55