Women with diabetes are far less likely to receive essential preventive healthcare services, including fertility counseling, birth control guidance, and cancer screenings, despite having more frequent doctor visits overall. A new meta-analysis of 44 studies examining reproductive-aged women found that these care gaps can lead to serious downstream complications, from unplanned pregnancies to delayed cancer diagnoses and higher-risk pregnancies that threaten both mother and baby .

What Preventive Care Are Women With Diabetes Actually Missing?

Researchers compared how often women with diabetes received key preventive services compared to women without the condition. The findings were striking across nearly every category. Less than half of women with diabetes received birth control counseling, compared to about 62 percent of women without diabetes . Women with diabetes were also 10 to 20 percent less likely to get cervical cancer screening .

Perhaps most concerning for those planning pregnancy, women with diabetes received fertility and prepregnancy counseling at extremely low and inconsistent rates. In some studies, as few as 1 percent of women with diabetes received this type of counseling . The research also revealed a major gap in sexually transmitted infection screening, with no studies even comparing rates between the two groups .

"What stood out most is that despite these women having more frequent interactions with the healthcare system, they were still missing out on important preventive care, not just in one area, but across the board," said Neha Narula, MD, a clinical assistant professor and primary care doctor at the Stanford University School of Medicine in California.

Neha Narula, MD, Clinical Assistant Professor and Primary Care Doctor at Stanford University School of Medicine

Why Does This Matter for Pregnancy and Fertility?

For women with diabetes who are planning to get pregnant, the stakes are particularly high. Unmanaged diabetes during pregnancy significantly increases the risk of serious complications for both mother and baby. These risks include birth defects, stillbirth, preterm birth, and an increased likelihood of needing a cesarean delivery . Additionally, diabetes can affect reproductive and sexual health by increasing the risk of yeast infections and urinary tract infections .

The lack of prepregnancy counseling means many women with diabetes may not be taking the necessary steps to optimize their health before conception. This missed opportunity can have lifelong consequences for both parent and child.

"This study doesn't highlight a small care gap, it has real consequences for women's health, with high-stakes downstream complications," said Neha Narula, MD.

Neha Narula, MD, Clinical Assistant Professor and Primary Care Doctor at Stanford University School of Medicine

Why Are These Care Gaps Happening?

The fragmented structure of the U.S. healthcare system is partly to blame. Many women with diabetes rely on their endocrinologist as their primary care doctor, but those appointments typically focus narrowly on blood sugar management and diabetes-related medications. Most endocrinology offices are not equipped to provide contraception counseling or age-appropriate cancer screening .

Beyond system-level issues, deeper disparities in healthcare access play a role. Groups at higher risk for diabetes, including younger adults, people with lower incomes, and many racial and ethnic minority populations, often face additional barriers to routine preventive services . As type 2 diabetes rates rise in younger adults, these overlapping challenges compound the problem.

"We're not especially good at care coordination. If one provider is focused on diabetes, someone else needs to be making sure preventive care is happening, and that doesn't always occur," said Lauren Wisk, PhD, an associate professor of medicine at UCLA Health in California.

Lauren Wisk, PhD, Associate Professor of Medicine at UCLA Health

How to Advocate for Your Preventive Care With Diabetes

Women with diabetes can take a more active role in ensuring their preventive care doesn't fall through the cracks. Here are concrete steps experts recommend:

• Ask Specific Questions: During appointments, directly ask your healthcare provider about family planning, age-appropriate cancer screenings, and other preventive services you should be receiving based on your age and health status.
• Stay Informed About What's Due: Research which preventive services are recommended for your age group, including cervical cancer screening, breast cancer screening, and fertility counseling if you're considering pregnancy.
• Work With a Trusted Provider: Establish a relationship with a primary care doctor who can track what preventive services are due and coordinate your care across multiple specialists, ensuring nothing gets overlooked.
• Schedule Dedicated Wellness Visits: Consider scheduling a separate appointment specifically for family planning and preventive care, rather than trying to address these topics during diabetes management visits.

"Preventive care is essential and should not be a secondary priority to chronic conditions such as diabetes," said Neha Narula, MD.

Neha Narula, MD, Clinical Assistant Professor and Primary Care Doctor at Stanford University School of Medicine

Having a dedicated primary care doctor is particularly important. Primary care physicians specialize in prevention and preventive services, making them well-positioned to ensure you receive comprehensive care alongside your diabetes management .

What Experts Want You to Know

The key takeaway from this research is that having diabetes doesn't eliminate your need for other essential health services. Cancer screenings, contraception counseling, and fertility planning are not luxuries or secondary concerns, they are fundamental components of comprehensive women's healthcare . Early detection through cancer screening leads to timely treatment and decreased mortality risk. Similarly, prepregnancy counseling for women with diabetes helps ensure the healthiest possible outcomes for both mother and baby .

While this study has some limitations, including reliance on small studies and patient recall in some cases, the overall pattern is clear and concerning. Future research should focus on improving care coordination and identifying when women are missing these preventive services . In the meantime, women with diabetes should advocate for themselves and ensure they're receiving the full spectrum of preventive care they deserve.