TNF and gestational diabetes: Though we cannot know whether first trimester elevation of free fatty acids that contribute to the development of gestational diabetes or the production of hyperglycemic placental molecules such as tumor necrosis factor-α (TNF-α), resistin, and leptin induces an increase on free fatty acids [43], animal studies have shown that the intentional addition of free fatty acids in pregnant rabbits induce insulin resistance, while their reduction has the contrary effect [44, 45].