This chapter gives overview of the role of ultrasound in the management of diabetic pregnancy. An association between diabetes mellitus in women and congenital malformations in their offspring has been suspected since the 19th century. Diabetes during pregnancy is associated with an increased rate of spontaneous abortions, intrauterine death, and several congenital anomalies involving different body systems of the fetus. This chapter covers the incidence, causative mechanism, biochemical parameters, and malformations. Diabetic embryopathy, a spectrum of congenital malformations or disruptions considered to be caused by maternal diabetes mellitus, is a diagnosis of exclusion. Small but statistically significant increase in holoprosencephaly (HPE), costovertebral, and genitourinary (GU) tract anomalies in offspring of women with gestational diabetes compared with women without diabetes.