Prescription of ace inhibitors for women in their reproductive years is increasing and is associated with increased risk of malformation. Women with diabetes use oral contraceptives less frequently than their nondiabetic counterparts. Insulin aspart shows now transplacental transfer and can be continued during pregnancy. The prognosis of women with microvascular complications, as well as that of their children, has improved due to optimized management of blood glucose and blood pressure. Gestational diabetes has doubled over the past 15 years – increased blood glucose leads to increased perinatal risks with no obvious threshold. Therapy with metformin carries no risk for the child. Diabetes manifestation in the mother following pregnancy can also be prevented effectively with metformin. All types of diabetes are associated with increased risk of malformations. After exposure to diabetes in utero there is a higher risk for early development of type 2 diabetes in adolescence. Cesaerean section increases the risk of type 1 diabetes as compared with vaginal birth.