INS and hyperinsulinism: While in the first trimester, the level of fasting serum insulin is similar to that in non-pregnant women, fasting serum insulin levels increase significantly during the second and third trimesters, due to the rise of diabetogenic hormones such as human placental lactogen, human chorionic gonadotrophin (HCG), growth hormone, and cortisol, which results in reduced insulin sensitivity, hyperinsulinemia [41].