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Diabetes is alarmingly high among Bangladeshi people. But there have been very few studies assessing the effect of diabetes on perinatal outcomes, particularly comparing diabetes prior to pregnancy and gestational diabetes (GDM). This cross sectional observational study was conducted in the Department of Obstetrics & Gynaecology, BIRDEM Hospital, Dhaka, Bangladesh from September 2010 to February 2011. Pregnant women admitted in BIRDEM Hospital for delivery after 28 weeks of gestation were selected to assess perinatal complications of GDM and diabetes prior to pregnancy and to compare them after taking permission from institutional review board. Perinatal complications of 50 women with gestational diabetes, 50 pregnant women with diabetes prior to pregnancy, and 50 non diabetic pregnant women as control were studied after taking written consent and the outcomes between GDM, and mother with diabetes prior to pregnancy were compared. Perinatal outcomes including congenital anomalies, birth asphyxia, macrosomia, respiratory distress syndrome (RDS), hypoglycemia, hyperbilirubinaemia, and perinatal mortality were compared. Neonatal complications were significantly higher in both pregnancy with prior diabetes (74%) and gestational diabetes (58%) when compared with non diabetic control (24%). Leading neonatal complications were macrosomia, birth asphyxia, hyperbilirubinaemia, and hypoglycemia. Macrosomia was significantly higher in GDM than non diabetic group (10% vs. 0%, p=0.003). Frequency of birth asphyxia, hyperbilirubinaemia, and hypoglycemia were significantly higher in the infant of mother with prior diabetes (22%, 54%, & 22% respectively) and GDM (20%, 38%, 18% respectively) than that of non diabetic mother (6%, 20%, 0% respectively). Compared to GDM, mother with prior diabetes had more frequent hyperbilirubinaemia (38% vs. 54%, p=0.004) and hypoglycemia (18% vs. 22%, p=0.04). Women with diabetes had worse pregnancy outcomes compared to non-diabetic mothers. Pregnancy prior to diabetes is associated with more frequent complications than gestational diabetes.