Feig et al. (2020) Furthermore, the MOMPOD trials support the use of metformin in combination with insulin for managing preexisting diabetes and GDM in early pregnancy, highlighting its significant role in improving maternal health outcomes (Boggess et al., 2023). Future clinical studies should extend their scope beyond GDM to explore metformin’s potential in addressing the metabolic challenges of pregnancies affected by T21, which is increasingly recognized as a metabolic syndrome (Moreau et al., 2021; Parfieniuk et al., 2018; Dierssen et al., 2020; Yahia et al., 2021). Here, INS is linked to metabolic syndrome.