Objective: Our purpose was to evaluate the association between birth weight (BW) and fetal death (FD) among pregnant nondiabetic and diabetic patients. Study Design: This was a retrospective cohort study using data for singleton births delivered between 1995 and 1997 in the United States (n = 10, 733, 983). Analysis was restricted to births that occurred at ≥20 completed weeks. FD rates among nondiabetic and diabetic patients (n = 271, 691) were determined for different 250-g BW categories. Adjusted relative risk (RR) and 95% CI for FD among diabetic compared with nondiabetic patients were derived through multivariable logistic regression models after potential confounders were controlled. Results: Overall FD rates for nondiabetic and diabetic patients were 4.0 and 5.9 per 1,000 births, respectively, with adjusted RR of 2.0 (95% CI 1.8-2.2). Maternal diabetes was associated with increased FD rate for all BW categories after 1250 g. Conclusion: The FD rate is increased when birth weight is ≥4250 g in nondiabetic patients and ≥4000 g in diabetic patients. ( Am J Obstet Gynecol 2002;187:922-6.)