It may be proposed that both pregnancy specific alterations and the implementation of a pre-pregnancy BMI threshold above which the genetic effect becomes the most significant may explain the difference found in the MTNR1B rs10830963 associated genetic effect sizes among type 2 diabetes mellitus (T2DM) [16,22,26] development; GDM development [11,20,27]; and AIT initiation in GDM reported here. This evidence concerns the gene MTNR1B and gestational diabetes.