A 4800 g (10.6 lb) male newborn is delivered at term to a 35-year-old woman, gravida 1, para 1. The pregnancy was complicated by gestational diabetes treated with insulin. However, glycemic control remained suboptimal due to maternal noncompliance with insulin treatment and poor adherence to dietary recommendations. His blood glucose concentration was found to be 30 mg/dL. Examination of the neonate is unremarkable. Which of the following is the most likely primary mechanism responsible for this patient's low blood glucose concentration?

Question

A 4800 g (10.6 lb) male newborn is delivered at term to a 35-year-old woman, gravida 1, para 1. The pregnancy was complicated by gestational diabetes treated with insulin.  However, glycemic control remained suboptimal due to maternal noncompliance with insulin treatment and poor adherence to dietary recommendations. His blood glucose concentration was found to be 30 mg/dL. Examination of the neonate is unremarkable.  Which of the following is the most likely primary mechanism responsible for this patient's low blood glucose concentration?

Quizplus · Accepted Answer

Eductional Objective: Neonatal hypoglycemia is common in infants of diabetic mothers.  The pathophysiology involves maternal hyperglycemia, which in turn causes fetal hyperglycemia and compensatory hyperfunctioning of the pancreas (ie, hyperinsulinemia).  After birth, persistently elevated insulin levels lead to transient hypoglycemia.

A 4800 G (10