The outlook for the fetus and infant of the diabetic mother has changed remarkably over the past 70 years. Following the discovery of insulin in 1922, young diabetic women who were previously practically infertile, were introduced to the option of conceiving and bearing children. Pregnancy-related maternal mortality, which had previously been extremely high in this group of patients, fell dramatically after the advent of exogenous insulin. Nevertheless, perinatal morbidity and mortality remained unacceptably high. Over the past 20 years, there has been growing understanding of the pathophysiology of the diabetic pregnancy, development of specialized health care centers for pregnant diabetic women, and remarkable improvements in neonatal care. All these have conjointly resulted in a markedly improved prognosis for the infant of the diabetic mother. Despite these optimistic undertones, it is prudent to bear in mind that these unborn infants developing in the sweet maternal environment are set out for a bitter struggle against some rather unfavorable odds.