The increased risk of T2DM among women who experience a preterm birth may be due to chronic low-level
inflammation (25,26). Several studies suggest that chronic low-level inflammation precedes the onset of T2DM (26–
28). As such, preterm birth could signal a chronic state of inflammation and an increased risk of future development of
T2DM. In addition, the association between macrosomia and T2DM, independent of GDM status, could be attributed
to maternal hyperglycemia, which is less overt than GDM and can lead to fetal hyperglycemia, exaggerated fetal insulin
response, and macrosomia. Therefore, macrosomia could simply indicate hyperglycemia in mothers, despite not
meeting clinical definitions for a GDM diagnosis. In fact, the Hyperglycemia and Adverse Pregnancy Outcomes
(HAPO) study found a continuous association between maternal hyperglycemia and increasing birth weight (15).