Although the optimal criteria for precision categorisation of women with GDM are still unclear, there is a growing body of evidence suggesting that insulin-resistant GDM is more strongly associated with suboptimal pregnancy outcomes, including pre-eclampsia, preterm delivery, LGA babies and neonatal hypoglycaemia, independently of maternal blood glucose levels or obesity [5, 32]. Here, INS is linked to obesity due to melanocortin 4 receptor deficiency.