(A) Birth weights in individuals without fetal insulin. Light green, INS (n = 21); blue, pancreatic agenesis (n = 43). Normal growth median, dark pink; the shaded pink area indicates ±2 SDs (INTERGROWTH-21^st, refs. 1, 8). The relationship between birth weight without fetal insulin and gestational age is shown by the line-of-best fit (solid blue) and 95% prediction intervals (dashed blue) from a univariable linear regression model. (B) Adjusted birth weight (40 weeks) in the absence of insulin in female (light gray, n = 31) and male (dark gray, n = 33) individuals. Center line, median; box limits, IQR; whiskers, 1.5 × IQR. Unpaired, 2-tailed Student’s t test was used. (C and D) Growth in first 4 years following insulin treatment in individuals with a recessive INS mutation. (C) Weight (orange circles, n = 10) and (D) length/height (green triangles, n = 7 birth, n = 9 postnatal), with large symbols showing the median. Measurements were standardized (SDS) for sex and gestational age/age (9). Absent data points for individuals were approximated from available data using linear interpolation.