Preexisting insulin - dependent diabetes increases the risk of the following: Pyelonephritis Ketoacidosis Preeclampsia Fetal death Major fetal malformations Fetal macrosomia (fetal weight > 4.5 kg) If vasculopathy is present, fetal growth restriction The need for preterm, cesarean, or operative delivery The incidence of fetal macrosomia is about 50% higher in pregnant women with preexisting diabetes than in pregnant women in the general population.