While the MODY4 IPF-1 P33T variant contributes to monogenic diabetes, gestational diabetes, low birth weight, miscarriages and early postnatal death,128 fetal undernutrition silences the transcription of Pdx1 (rat homologous of MODY4 IPF-1) via promoter DNA methylation and histone modifications.129. Here, PDX1 is linked to gestational diabetes.