SERPINE1 and gestational diabetes: One large meta-analysis spanning almost 33 years investigating the role of the PAI-1 gene in adverse pregnancy and gynecological complications described the complex role of the PAI-1 gene in various reproductive failures, including recurrent pregnancy loss (RPL), pre-eclampsia (PE), gestational diabetes (GDM), impaired fetal growth (FGR), repeated implantation failure (RIF), polycystic ovary syndrome (PCOS), and endometriosis [50].