Chronic complications of diabetes, such as nephropathy, autonomic neuropathy, nephropathy, and hypertension, can worsen during pregnancy and represent additional risk factors for adverse maternal and fetal outcomes. A multidisciplinary and proactive approach aiming to optimize metabolic control and carefully monitor pre-existing chronic complications from the pre-conception stage is essential. Attention should be paid to therapeutic education, strict glycemic control, management of potentially teratogenic medications, and early and continuous monitoring of complications throughout pregnancy.