TNF and gestational diabetes: There have been many reports on the improvement of berberine on hepatic IR by anti-inflammatory mechanisms, such as inhibiting IKK/NF-κB, JNK, and IRS-1/AKT pathways in gestational diabetes mellitus rats [42], attenuating ERK1/2-induced serine phosphorylation of IRS-1 and thus enhancing Akt (T308) activation in primary hepatocytes pre-treated with TNF-α [43], and inhibiting LPS/TLR4/TNF-α signaling in HFD-fed obese rats [44].