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Purpose To assess gestational weight gain (GWG) according to Institute of Medicine (IOM) and its clinical predictors in women with type 1 and type 2 diabetes. Methods Retrospective cohort study at a tertiary medical center. GWG after IOM, was assessed both uncorrected and corrected for gestational age. General and diabetes-related characteristics were analyzed as GWG predictors. Results We evaluated 633 pregnant women with type 1 and type 2 diabetes. GWG uncorrected for gestational age was insufficient (iGWG) in 20.4%, adequate in 37.1% and excessive (eGWG) in 42.5%. GWG predictors included general (height, prepregnancy body mass index category, multiple pregnancy) and diabetes-related characteristics. Neuropathy and follow-up length were associated with iGWG (OR 3.00, 95% CI 1.22–7.37; OR 0.92, 95% CI 0.86–0.97 respectively) while pump use and third trimester insulin dose were associated with eGWG (OR 1.68, 95% CI 1.07–2.66; OR 3.64, 95% CI 1.88–7.06 respectively). Independent predictors for corrected GWG also included general and diabetes-related characteristics. Conclusion In this cohort of women with type 1 and type 2 diabetes, inadequate GWG was common at the expense of eGWG and associated clinical characteristics were both general and diabetes-related. Clinical care during pregnancy for these women may favor weight gain.