Women with diabetes have a higher risk for complications of pregnancy than do women without diabetes; in addition, infants born to women with diabetes are at increased risk for adverse birth outcomes. Preconception counseling for women with established diabetes and early and continual prenatal care for women with established or gestational diabetes can reduce maternal and infant morbidity and mortality. Although the rate of pregnancy complicated by diabetes and the use of prenatal care varies by race of the mother, it is unknown whether the effect of diabetes on maternal and infant outcomes differs by race. Race reflects differing distributions of several risk factors for pregnancy outcomes (e.g., socioeconomic status and access to comprehensive health care) and is useful for identifying groups at greatest risk for adverse outcomes. To determine the prevalence of diabetes during pregnancy among women residing in North Carolina and to characterize differences in prenatal care and the risk for maternal complications and adverse pregnancy outcomes by race among mothers with diabetes, the North Carolina State Center for Health and Environmental Statistics examined birth certificates of infants of women who gave birth in the state during 1989-1990. This report summarizes the findings of the study.