Cox proportional hazards models were used to estimate hazard ratios (HRs) across three groups, offspring born to mothers without GDM (reference), with GDM but not treated with insulin, and with GDM treated with insulin, adjusting for maternal and neonatal covariates.<h4>Results</h4>Of the total cohort, 424,185 (12.1%) pregnancies were complicated by GDM, among which 30,003 (7.1%) required insulin therapy during pregnancy. This evidence concerns the gene INS and gestational diabetes.