Background/Objectives: Gestational diabetes mellitus (GDM) represents one of the most common pregnancy-related disorders and it is correlated to increased risks of adverse maternal and neonatal outcomes. The prognostic role of initial glycemic values in predicting neonatal hypoglycemia and other complications remains underexplored. Methods: This retrospective study analyzed 233 women diagnosed with GDM between 2018 and 2024. Participants were stratified into three risk groups based on diagnostic oral glucose tolerance test (OGTT) values: low-risk group (fasting plasma glucose [FPG] 92–100 mg/dL, 1 h < 180 mg/dL, 2 h < 153 mg/dL), intermediate-risk group (FPG 101–110 mg/dL or 1 h 180–190 mg/dL or 2 h 153–163 mg/dL), and high-risk group (FPG > 110 mg/dL or 1 h > 190 mg/dL or 2 h > 163 mg/dL). Neonatal hypoglycemia was defined as the primary outcome, whereas secondary outcomes comprised insulin requirements, continuous glucose monitoring (CGM) use, macrosomia, polyhydramnios, and perinatal complications. Results: Non-significant differences across groups were observed except for Caucasian predominance in the high-risk group. Hypoglycemia trended higher in intermediate- and high-risk groups (26% and 21% vs. 17%), as well as polyhydramnios (14.3% and 13.8% vs. 4.5%) without statistical significance. Overall metabolic control was excellent, with almost 70% of patients maintaining HbA1c values ≤ 5.5% throughout the pregnancy with early and limited use of insulin therapy (17.3%). Conclusions: Diagnostic OGTT stratification provides limited prognostic value in optimized GDM care with early CGM and insulin use. Although trends for hypoglycemia and polyhydramnios suggest potential utility, the excellent metabolic control likely flattened the differences between groups. Prospective trials with CGM metrics are needed to develop more refined risk models, potentially enabling a more personalized management.

Background/Objectives. Pediatric brain tumor survivors (PBTS) are at increased risk of cardiometabolic complications due to tumor- and treatment-related hypothalamic–pituitary (HP) damage and adverse body composition. We evaluated associations of the Single-Point Insulin Sensitivity Estimator (SPISE) with central adiposity, DXA-derived body composition, metabolic abnormalities, and HP involvement. Methods. In this retrospective study, 119 PBTSs (median age, 12.7 years; median time since therapy, 2.4 years) were evaluated. SPISE, BMI, waist-to-height ratio (WHtR), DXA-derived fat-to-lean ratio (FLR), and metabolic syndrome (MetS) were assessed. Multivariable logistic regression evaluated the association between SPISE and central adiposity. Exploratory receiver operating characteristic analyses compared the discriminatory performance of SPISE, BMI-SDS, HOMA-IR, and FLR. Results. Central adiposity was present in 58.8% of participants, whereas BMI-defined obesity occurred in 21.8%. Lower SPISE values were associated with central adiposity, obesity, MetS, HP damage, and multiple pituitary hormone deficiencies (all p < 0.05). SPISE declined across pubertal stages and remained associated with central adiposity after adjustment for age and selected HP variables (OR = 0.58, 95% CI 0.46–0.73). SPISE showed good discrimination of central adiposity (AUC = 0.81), with an exploratory, cohort-derived threshold of 7.82; FLR provided complementary information on body composition. Conclusions. Central adiposity was common and not fully captured by BMI-defined obesity. Lower SPISE values were associated with concurrent anthropometric and metabolic abnormalities, while DXA-derived FLR added descriptive information on body composition. Whether these indices improve cardiometabolic risk stratification beyond conventional measures requires prospective investigation.