GHRL and spina bifida: Future studies on the Ghrelin/LEAP-2 ratio in pregnant women could contribute to the early prediction of adverse maternal and perinatal outcomes, and to the implementation of measures in early pregnancy to reduce the risk of adverse outcomes related to metabolic control of appetite and energy homeostasis, including miscarriage, gestational diabetes, preeclampsia, macrosomia, large for gestational age, stillbirth, congenital heart defects, spina bifida, preterm birth, cesarean delivery, postpartum hemorrhage and postpartum infection [28].