INS and obesity due to melanocortin 4 receptor deficiency: The dysregulation in question is typically associated with the metabolic syndrome, which involves obesity, high blood pressure, and abnormal lipid levels, all recognized as contributors to the risk of experiencing adverse pregnancy outcomes, including Preterm delivery [31].The insulin signaling pathway, which is crucial for glucose uptake and metabolism, becomes disrupted in IR, further exacerbating hyperglycemia [32].Elevated blood glucose can lead to systemic inflammation and oxidative stress, which are detrimental to both maternal and fetal health.