PDX1 and obesity due to melanocortin 4 receptor deficiency: Another epigenetic effect of high free fatty acid in the offspring of women with obesity is the silencing of homeobox gene Pdx-1 which increased islet cell apoptosis and worsens the failing hyperplastic islet cells in newborn observed in women with obesity, setting the stage for early pancreatic exhaustion and type 2 diabetes in the offspring of women that were obese during pregnancy (68).