Introduction The appropriate management of pregnant women with comorbidities is a routine challenge, requiring efforts to obtain a favorable outcome. Gestational diabetes mellitus (GDM) is associated with increased perinatal mortality and perinatal morbidity, with high rates of macrosomia, birth trauma, metabolic, hematologic and respiratory complications. The risk reduction for patients with preeclampsia requires rigorous clinical control of blood pressure (BP) (BRAZIL, 2011). Case report Patient F.R.A. 34 years old, brown, multiparous (5 pregnancies, 2 vaginal deliveries and 2 miscarriages), with a history of GDM and abortion in previous pregnancy without comorbidities, accompanied by pre-natal high-risk service, held 9 queries, presented at the tenth week of gestation one fasting blood glucose of 105 mg/d, conducted the oral glucose tolerance test with 75 mg, which submitted the relevant values: 96 mg/dL, 146 mg/dL, 131 mg/dL. She made use of NPH insulin, but has abandoned use in the last month of pregnancy, and there were no other changes in the other prenatal tests. She was admitted in a tertiary center at 30 weeks and 3 days pregnancy (calculated in ultrasonography exam) due to hypertensive frame (150 × 100 mmHg), referring pain in the epigastric region, fetal movements present and without uterine activity. The patient underwent ultrasonography obstetric showed intrauterine growth restriction (IUGR), oligohydramnios and small placenta. Furthermore, the umbilical artery Doppler presented diastole zero and middle cerebral artery with decreased vascular resistance. The ductus venosus presented wave “A” positive above the baseline. During hospitalization was monitored for blood pressure and blood glucose without amendments. It was pointed out by cesarean section DMG, IUGR and zero diastole. The newborn (NB), male, weight 830 g, cried, presented tone and did not require resuscitation. The Capurro calculated was 34 weeks and five days, with no malformations. The NB evolved with respiratory distress, requiring intubation and intensive care. Postpartum was not performed glycemic control of the patient and the same was discharged after two days. Relevance and comments The risk of preterm birth and perinatal mortality are added in association significant obstetric pathologies. The quality of care is critical to minimize adverse outcomes and maternal effects as pre-eclampsia and polyhydramnios, in addition to fetal repercussions example of prematurity and perinatal mortality.