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We aimed to synthesize observational evidence on associations of modifiable preconception, pregnancy and postpartum risk factors with perinatal outcomes among women with pregestational T2D.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Searches were conducted in six databases (September 2023). Observational studies among women with pregestational T2D were included if they reported associations of modifiable risk factors with maternal and\/or child outcomes. Screening, data extraction and quality assessments were conducted by two reviewers. Findings were synthesized through random effects meta\u2010analysis or narrative synthesis when results were too few or heterogeneous to pool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Searches identified 15,578 results; 58 studies were included. Meta\u2010analysis showed excessive gestational weight gain (GWG) was associated with large for gestational age (LGA) (OR 2.39, 95%CI 1.74\u20133.29) but not small for gestational age (SGA). Meta\u2010analysis demonstrated no associations between preconception care or metformin use with adverse pregnancy, birth and neonatal outcomes. However, narrative synthesis showed preconception care was associated with increased use of folic acid and vitamin D, and reduced GWG. Further narrative synthesis findings showed that higher BMI was associated with multiple suboptimal pregnancy, birth and neonatal outcomes. Excessive GWG was associated with increased insulin requirements and increased likelihood of neonatal hypoglycaemia. The use of metformin\/oral hypoglycaemic medications was associated with reduced GWG and fewer caesarean deliveries. There was mixed or no evidence of association for other reported exposures and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Based on observational evidence, increasing access to preconception care could be beneficial to optimize maternal nutrition and weight\u2010related outcomes, and addressing obesity and GWG has the potential to improve maternal and neonatal outcomes in pregnancies affected by T2D.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dme.70183","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T04:14:52Z","timestamp":1765167292000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Associations of modifiable preconception, pregnancy and postpartum factors with health outcomes for women with type 2 diabetes and their children: A systematic review and meta\u2010analysis of observational studies"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7652-990X","authenticated-orcid":false,"given":"Danielle","family":"Schoenaker","sequence":"first","affiliation":[{"name":"School of Human Development and Health, Faculty of Medicine University of Southampton  Southampton UK"},{"name":"MRC Lifecourse Epidemiology Centre University of Southampton  Southampton UK"},{"name":"NIHR Southampton Biomedical Research Centre University of Southampton, and University Hospital Southampton NHS Foundation Trust  Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4797-1459","authenticated-orcid":false,"given":"Eleanor","family":"Dyer","sequence":"additional","affiliation":[{"name":"Population Health Sciences Institute Newcastle University  Newcastle upon Tyne UK"},{"name":"Fuse, the Centre for Translational Research in Public Health Newcastle University  Newcastle upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Heslehurst","sequence":"additional","affiliation":[{"name":"Population Health Sciences Institute Newcastle University  Newcastle upon Tyne UK"},{"name":"Fuse, the Centre for Translational Research in Public Health Newcastle University  Newcastle upon Tyne UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grainne","family":"Kent","sequence":"additional","affiliation":[{"name":"School of Population Health Royal College of Surgeons in Ireland  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sowmiya","family":"Gunabalasingam","sequence":"additional","affiliation":[{"name":"Department of Women and Children's Health, School of Life Course and Population Sciences King's College London  London 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