INS and obesity due to melanocortin 4 receptor deficiency: These outcomes are largely a result of the intrauterine environment with increased concentration of glucose and subsequent enhanced insulin secretion in the fetus, increased risk of injury during birth, and susceptibility to markedly increased adiposity during infancy and obesity-related long-term morbidities.4 Epidemiological studies have identified several risk factors for GDM such as advanced maternal age, maternal overweight and obesity, ethnicity, previous history of GDM, and family history of type 2 diabetes mellitus.