Table 2.

First- and second-order constructs

Study	First-order constructs (sample of quotations)	Second-order constructs (themes in articles)
Spence et al24	“I’ve only been told the second time I went [for clinic appointment], and they said ‘Oh, by the way, if you’re planning to get pregnant, you know, you have to go on insulin’. So I thought that’s … I could have got pregnant all that time before!” “It’s just the whole attitude, you know, it was like it didn’t matter … maybe I’m just one person, but it’s important for me if it’s not for them.”	Knowledge Quality of relationships with HCPs Organization of care The impact of beliefs and attitudes on advice giving Women’s attitudes to prepregnancy care advice
Murphy et al25	“I mean we weren’t really thinking about it at that time so I mean it was all like pushed to one side. Yeah, so I probably wouldn’t have taken much notice about it if they would have said anything.” “Yes I was given information by my GP’s nurse, but I did not use contraception … My husband said, do not use any contraception we want a baby.” “I went on to insulin and I was on insulin for a year or two trying to have a baby and they said they didn’t think I could … then I changed doctors last year because mine was useless and they put me on a tablet [Rosiglitazone] and 7 years later I’m pregnant …”	Women’s views of preconception counseling Contraceptive behaviors Knowledge regarding the risks of diabetes during pregnancy Past pregnancy experiences Becoming pregnant Attending PPC
Lavender et al23	“She would have attended preconception care had she known that the service existed.” “It’s more miscarriage, its more stillbirth. I mean, I know that doesn’t always have to be the way but it seems to me that if you’ve already got problems anyway they just escalate and escalate, so I don’t know, I’m frightened … you just have to wait and see if something really horrible happens to it [baby] but you just do your best to try and make sure that it doesn’t.”	Relinquishing personal control Pregnancy overshadowed by DM Haphazard PPC
Letherby et al26	“… from a time perspective that, one – being diabetic and secondly knowing that I was getting older … we finally sort of sat down and said, Look you know, if we’re going to do this, we need to do it new, or forget about it.”	Timing of pregnancy
Nekuei et al27	“Not much attention was paid to this issue during the training courses, and now that we have only received subtle training; our information is not sufficient.” “Preconception consultation requires a great deal of time as well as skill. Responsible personnel for this practice do not have the needed motivation to spend their time on this issue.” “All members of the health team shift the blame onto each other and think that they have done their duties correctly.”	Health centers’ weakness in providing PPC for diabetic women Lack of a comprehensive PPC plan for diabetic women Diabetic women’s negligence about having planned pregnancy
Mersereau et al29	“They’re more concerned about are they going to have to take insulin … they don’t want to check their sugars.” “The type 2’s especially … haven’t been educated on the importance of getting their blood sugars in control prior to getting pregnant and getting prenatal care started.” “It’s really interesting, the cultural things going on sometimes. In what he [the husband] perceives to be good for the pregnancy or what the patient’s mother-in-law thinks should go on for their future grandchild.”	HCPs consider most pregnancies are unplanned Women express concerns for the baby rather than themselves Barriers to care are a lack of knowledge, lack of access, and attitude to the need for care
Mortagy et al28	“… part of the problem is, type 2 diabetes for a lot of people is seen as a disease of the elderly. And more of our patients are middle-aged to old people, so I think the kind of, you know, diabetes, think about pregnancy, is not automatic at all …” “Frankly [in] general practice, you’re under such pressure in terms of time in a general consultation, you know, you might have 10 minutes, it’s um, unless there is a system that alerts you to um, to consider it, it’s unlikely to get into, you know, you’re just dealing with now.”	Case load and patient profile Ambiguity of roles and responsibilities of GPs Missed opportunities Integration of care

Abbreviations: DM, diabetes mellitus; GPs, general practitioners; HCPs, health care professionals; PPC, prepregnancy care.