However, we show that: (1) the risk of cardiac malformations is increased for women with insulin-treated GDM, whereas the risk of nervous system malformations is not; (2) the risk of respiratory distress is also increased for this subgroup of insulin-treated women with GDM; and (3) the risk of perinatal mortality increases with GDM for deliveries after 37 weeks. Here, INS is linked to gestational diabetes.