TNF and Insulin resistance: Pregnancy naturally induces a state of progressive insulin resistance, especially in the second and third trimesters, mediated by placental hormones (human placental lactogen (hPL)), prolactin, progesterone, cortisol, estradiol, cytokines, and adipokines (e.g., tumor necrosis factor α (TNF-α), leptin, resistin) [2,9].