Similarly, the offspring of US mothers with obesity who had nonspecified pregestational diabetes had an increased risk of ASD (HR, 3.9; 95% CI, 1.8-8.7).19 In addition, the offspring of severely obese mothers with type 2 diabetes had a more than 2-fold risk for specific developmental disorders compared with the offspring of normal-weight mothers without diabetes, whereas the corresponding effect size for obese mothers with insulin-treated pregestational diabetes was almost 3 times. Here, INS is linked to diabetes mellitus.