Objective: To compare perinatal complications in diabetic women (DW) and nondiabetic women (NDW). Methods: We analyzed data obtained from our perinatal database for DW delivered at our center between 1990 and 1999 and frequency-matched to a group of NDW of the same ethnicity and parity delivering within 28 days. Results: Data were analyzed for 2,978 DW and 2,567 NDW. The ethnic distribution was nearly identical in both groups; the overall distribution was 23% African Americans, 23% whites, 35% Hispanics, 15% Haitians, and 4% other. Compared with NDW, DW were slightly older (mean ± SD: 30.8 ± 6.3 years versus 29.7 ± 6.4 years, P <0.001), delivered heavier babies (3,441 ± 825 g versus 3,169 ± 798 g, P <0.001) at comparable mean gestational age (GA) (38.0 ± 3.2 weeks versus 38.0 ± 4.2 weeks, P = 0.825). Also, DW were twice as likely to have a cesarean delivery (OR [95%CI] = 2.0 [1.9,2.3]), almost five times more likely to have a shoulder dystocia (OR = 4.6 [2.6,7.7]), and as likely to have an episiotomy (EP) (OR = 1.2 [1.0,1.4]). No significant difference was seen in the risk of lacerations. When excluding EP, DW were 30% more likely to have any lacerations (OR = 1.3 [1.1,1.5]). Comparisons with respect to birth weight were made within separate strata of GA. The odds of delivering a baby greater than 4,000 g were 11 times higher for DW delivering at 34–36 weeks (OR = 11.2 [2.5,33.4]), and 3 times higher at 37–41 weeks (OR = 3.0 [2.5,3.5]). Term babies born to DW were 40% more likely to be admitted to the intensive care unit (OR = 1.4 [1.2,1.6]). Conclusion: Despite increased glucose control over the past decade, perinatal morbidity (mother and child) remains high.