AGT and obesity due to melanocortin 4 receptor deficiency: Aside from the possible contributions of shared genetic background and lifestyle, obesity can increase blood pressure, eg, by directly disrupting placental-fetal circulation via sphingolipids, such as ceramides,36 or interacting with HDP by inducing angiotensin II–elicited hypertensive responses.23 Obesity co-occurring with gestational diabetes may increase insulin resistance and adiponectin suppression, which may subsequently modify fetal vascular tone by diminishing the production of nitric oxide and inducing endothelial dysfunction.37