Over the past 50 years, maternal mortality for the pregnant diabetic has been reduced by half. In the period from 1957 to 1974, 24 pregnant diabetic women died in Los Angeles County. Seven deaths were directly attributed to the metabolic complications of diabetes. Fatal ketoacidosis occurred in the second and third trimesters, while hypoglycemia led to death in the first trimester or postpartum period. Of 15 patients alive at the onset of labor, 8 were delivered by cesarean section. Four of these women died from sepsis and 3 from hemorrhage. In contrast to other reports, vascular disease contributed to only 1 fatality.