Second, due to the retrospective nature of our study, certain potential confounders not documented or with substantial missing values in medical records were not adjusted for, such as maternal pre-pregnancy obesity, gestational weight gain, and management of GDM (e.g., lifestyle interventions including dietary control and exercise, as well as medical therapy including insulin and metformin), which may cause residual confounding. The gene discussed is INS; the disease is obesity due to melanocortin 4 receptor deficiency.