ATF4 and gestational diabetes: To the best of our knowledge, this is the first study to propose ADSC/GDM-derived sEVs as "switches" that upregulate Thbs1 and induce the increase of ERS signaling-related proteins Atf4 and Atf6 in AML-12 cells, thereby damaging cellular insulin sensitivity and promoting the formation of IR in GDM mice.