Background. It is unknown whether adverse pregnancy-related outcomes in women with pregestational diabetes are associated with later development of end-stage renal disease (ESRD) or death. Methods. We linked data from the Medical Birth Registry of Norway with data from the Norwegian Renal Registry and the Norwegian Cause of Death Registry. Data from up to three pregnancies for women with a first singleton delivery from 1967 to 1994 were included and analysed in a cohort design using Cox regression. Results. Altogether, 639 018 women were included in the analyses, among whom 2204 women had diabetes mellitus before pregnancy. Their first pregnancy was complicated by pre-eclampsia in 13.2%, low birth weight offspring (