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 The gene discussed is ADIPOQ; the disease is obesity due to melanocortin 4 receptor deficiency.