There are three possible explanations: (1) PCOS has different characteristics and clinical impact in different ethnic groups, (2) increased insulin resistance in PCOS has different clinical effects depending on the insulin metabolism characteristic of different ethnicities and environments, and (3) the prevalence of GDM in women with PCOS is affected by the different diagnosis criteria (the WHO or the modified IADPSG criteria) [3, 17]. Here, INS is linked to gestational diabetes.