Between 1983 and 1986, 914 single births to women with diabetes mellitus before pregnancy and a randomly selected control sample of 4000 births were identified by using the Swedish Medical Birth Registry. Twenty-four percent of diabetic women were delivered preterm, as compared with 6% in the control group. The rates of late fetal death were a 1.3% among infants born to women with diabetes and 0.4% in the control group. Infant mortality was 0.9% and 0.5% among infants to mothers with and without diabetes mellitus, respectively. The increased rates of late fetal and infant deaths in the diabetes group were largely explained by higher mortality in the more prevalent preterm deliveries. Fourteen of 20 late fetal and infant deaths occurred among preterm infants in diabetic pregnancies, while in the control group, 17 of 33 late fetal and infant deaths occurred among preterm infants. Elimination of the increased rates of late fetal death and congenital malformation in diabetic pregnancy is required to meet the goals of the St Vincent Declaration. A nation-wide registry of diabetic pregnancy outcomes is feasible and necessary for further quality assurance of diabetic pregnancies.