Objective: To determine whether the St Vincent declaration (1989) target of diabetic pregnancy outcome approximating non-diabetic pregnancy outcome is near to being achieved. Design: Prospective collection of population based information on pregnancies in women with diabetes from all participating hospitals. Setting: District general and teaching hospitals of the former Northern region. Subjects: 111 diabetic women booking with pregnancy during 1 January to 31 December 1994. Main outcome measures: Diabetic control, perinatal mortality rate, fetal abnormality rate. Results: The perinatal mortality rate was 48/1000 for diabetic pregnancies compared with 8.9/1000 for the background population (odds ratio 5.38; 95% confidence interval 2.27 to 12.70) and the neonatal mortality rate was 59/1000 compared with 3.9/1000 (15.0; 6.77 to 33.10). Two late neonatal deaths were due to congenital heart defects. Six per cent of all fetal losses (6/109 cases) were due to major malformations. The congenital malformation rate was 83/1000 compared with 21.3/1000 (3.76; 2.00 to 7.06) in the background population. Conclusion: Diabetic pregnancy remains a high risk state with perinatal mortality and fetal malformation rates much higher than in the background population. Though diabetic women who plan their pregnancies receive prepregnancy advice, most have poor diabetic control at conception In diabetic pregnancies the perinatal mortality rate is five times higher, the neonatal mortality rate 15 times higher, and the congenital malformation rate four times higher than in the background population There is a substantial excess of premature births in diabetic pregnancies The outcome of diabetic pregnancy remains poor; better uptake of preconceptional care may improve outcome