Strengths and limitations
This study had some limitations that require comments. The first is the fundamental limitation of the single-center retrospective study design. Nevertheless, this single-center design involved a uniform prenatal screening protocol and patient management, as well as standardized data collection for adverse pregnancy outcomes. Second, primary CS was not included among adverse pregnancy outcomes since it is not the result of an adverse pregnancy outcome but rather a preference in Korea, where the CS rate is high. Third, the lack of information on insulin levels constrained the investigation of the association between insulin response and OGTT patterns. Finally, the lack of information on long-term adverse events, such as maternal future diabetes mellitus or early childhood obesity, hindered us from completely covering the natural course of overall adverse pregnancy outcomes. Therefore, larger and longer-term clinical studies are warranted to arrive at definite conclusions.