Diabetes mellitus is known to complicate 6–9% of all pregnancies worldwide. In India, prevalence of gestational diabetes mellitus (GDM) varies from region to region. Pregnancies complicated with diabetes are at high risk for first trimester pregnancy loss, congenital anomalies, aneuploidy, macrosomia, intrauterine growth restriction (IUGR), preterm delivery (both spontaneous and iatrogenic), premature rupture of membranes, and stillbirth. Neonates suffer birth trauma, hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia, and consequences of prematurity and congenital malformations. Congenital anomalies contribute to 50% of prenatal mortality and half of it is due to cardiac abnormalities. In second and third trimester, uncontrolled blood sugars may lead to macrosomia in fetus. Maintaining maternal plasma glucose levels within the euglycemic range in pregestational period and throughout the pregnancy and monitoring of fetus are the two essential elements of management of a diabetic pregnancy.