Advances in the management of mothers with diabetes have reduced the rate of morbidity and mortality for their infants. Aggressive control of maternal glycemic status is warranted because most morbidities are epidemiologically and pathophysiologically closely linked to fetal hyperglycemia and hyperinsulinemia. Although rates of complications are lower than in previous eras, there may be a resurgence of IDMs within the next 10 years. The burgeoning public health problem of overweight and obesity in children likely will result in an increased incidence of metabolic syndrome X, characterized by insulin resistance and type II diabetes in adulthood. An early manifestation of this may be glucose intolerance during pregnancy in overweight women without diabetes. Clinicians must continue to have a high degree of suspicion for the diagnosis of diabetes during gestation and for screening the offspring of women with gestational diabetes for neonatal sequelae.