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.