To minimize risks associated with pregnancy and type 1 diabetes, preconception counseling and care are critical. Preconception care with tight glycemic control improves outcomes including lower cesarean rates (88), decreased perinatal mortality (89–91), and decreased congenital malformations (89–97). Although there is some evidence that childbearing may be reduced (98–100), in general, fertility should be assumed to be normal, and all young women with type 1 diabetes should receive preconception counseling covering diabetes and general topics, including use of prenatal vitamin, discontinuation of potentially teratogenic medications, and the importance of glycemic control to reduce the risk of congenital malformations.