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This axis comprises two growth factors, IGF\u2010I and IGF\u2010II, and six insulin\u2010like growth factor\u2013binding proteins (IGFBPs), modulating IGF activity. Due to their structural similarity to insulin, IGFs can interact with insulin receptors, facilitating glucose uptake in adipose and muscle tissues, suppressing hepatic glucose production, and modulating blood glucose levels. Pregnancy induces unique metabolic challenges, with the IGF axis adapting to support maternal metabolic changes and fetal growth. In pregnancies complicated by prediabetes or diabetes, disruptions in the IGF axis, including altered levels of IGFs and IGFBPs, have been linked to adverse outcomes such as macrosomia and intrauterine growth restriction. This review discusses the role of the IGF system in pregnancies with diabetes, focusing on how dysregulation of IGFs and IGFBPs contributes to pregnancy complications. 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