TNF and Insulin resistance: High ferritin levels in patients with GDM can be due to chronic inflammation (IL-6, TNF-α-driven ferritin synthesis) and insulin resistance (enhanced intestinal iron absorption) contributes to paradoxical iron overload (39), which may impair placental function via oxidative stress (ROS) (40) and provide a possible explanation for the negative relationship between ferritin level and neonatal birthweight.