SERPINA7 and Insulin resistance: From a biochemical perspective, insulin resistance—a hallmark of GDM—may influence thyroid hormone metabolism through altered deiodinase activity, changes in leptin and adipokine signaling, and pro-inflammatory cytokine pathways (6–8).Additionally, elevated estrogen levels during pregnancy can increase thyroxine-binding globulin (TBG), altering free thyroid hormone levels (9).