OBJECTIVE: To determine the impact of maternal diabetic glucose control on fetal cholesterol homeostasis. METHODS: Singleton pregnancies of 150 women complicated by gestational (n = 90) and pre-gestational (n = 60) diabetes were evaluated. Those with insulin-requiring diabetes had fasting blood glucose levels determined daily during the last 4 weeks of pregnancy and weekly fasting glucose values were obtained in those with A1 (diet-controlled) gestational diabetes. Umbilical cord venous serum was collected at delivery and total cholesterol levels were determined. RESULTS: Among the 150 women, 69 had A1 gestational diabetes and 81 were insulin-requiring. Fasting glucose levels were inversely correlated (p < 0.001) to gestational age, regardless of diabetes classification. Umbilical serum cholesterol levels were inversely related (p < 0.002) to gestational age and weight, but did not vary according to diabetic classification. Among term infants (n = 110), umbilical serum cholesterol levels were inversely related to maternal fasting glucose levels at 4 weeks (p = 0.006) and 2 weeks (p = 0.006) before delivery. CONCLUSION: Maternal hyperglycemia is associated with decreased plasma fetal cholesterol levels in term infants.