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Introduction: Despite technological developments and intensified care, pregnancies in women with pre-existing diabetes are still considered high-risk pregnancies. The rate of adverse outcomes in pregnancies affected by diabetes in Denmark is currently unknown, and there is a limited understanding of mechanisms contributing to this elevated risk. To address these gaps, the Danish Diabetes Birth Registry 2 (DDBR2) was established. The aims of this registry are to evaluate maternal and fetal-neonatal outcomes based on 5 years cohort data, and to identify pathophysiology and risk factors associated with short-term and long-term outcomes of pregnancies in women with pre-existing diabetes., Methods and Analysis: The DDBR2 registry is a nationwide 5-year prospective cohort with an inclusion period from February 2023 to February 2028 of pregnancies in women with all types of pre-existing diabetes and includes registry, clinical and questionnaire data and biological samples of mother-partner-child trios. Eligible families (parents age ≥18 years and sufficient proficiency in Danish or English) can participate by either (1) basic level data obtained from medical records (mother and child) and questionnaires (partner) or (2) basic level data and additional data which includes questionnaires (mother and partner) and blood samples (all). The primary maternal outcome is Hemoglobin A1c (HbA1c) levels at the end of pregnancy and the primary offspring endpoint is the birth weight SD score. The DDBR2 registry will be complemented by genetic, epigenetic and metabolomic data as well as a biobank for future research, and the cohort will be followed through data from national databases to illuminate possible mechanisms that link maternal diabetes and other parental factors to a possible increased risk of adverse long-term child outcomes., Ethics and Dissemination: Approval from the Ethical Committee is obtained (S-20220039). Findings will be sought published in international scientific journals and shared among the participating hospitals and policymakers., Trial Registration Number: NCT05678543., Competing Interests: Competing interests: SK: None. JA: None. MO: MO holds stocks in Novo Nordisk. HS: None. ERM: ERM has participated in clinical studies on the use of insulin in pregnant women with pre-existing diabetes in collaboration with Novo Nordisk. Papers from these studies are still being produced. No personal honorarium was involved. LR: LR has received a grant from Novo Nordisk A/S for an investigator-sponsored study. Grant number: U1111-1209-6358. LR participated in the European Association for the Study of Diabetes annual meeting 2023 as an invite by Novo Nordisk. PD: PD has participated in clinical studies on the use of insulin in pregnant women with pre-existing diabetes in collaboration with Novo Nordisk. Papers from these studies are still being produced. No personal honorarium was involved. TDC: TDC has participated in clinical studies on the use of insulin in pregnant women with pre-existing diabetes in collaboration with Novo Nordisk. Papers from these studies are still being produced. No personal honorarium was involved. UB-C: None. AK-E: None. JL: None. LLTA: None. CV: None. UK: None. JF: JF holds stocks in Novo Nordisk. PGO: None. TTC: TTC participated in the European Association for the Study of Diabetes annual meeting 2023 as an invite by Novo Nordisk. AS: None. DMJ: None., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)