A 35-Year-Old Woman at 38 Weeks Gestation Undergoes Induction of Labor

A 35-year-old woman at 38 weeks gestation undergoes induction of labor.  The patient has type 2 diabetes mellitus, and her blood glucose levels were increasingly difficult to control during her third trimester despite increasing doses of insulin.  During induction, the patient develops arrest of labor and undergoes a cesarean delivery.  Apgar scores are 8 and 9 at 1 and 5 minutes, respectively.  Physical examination shows a newborn large for gestational age with a birth weight of 4.6 kg (10.1 lb) .  The remainder of the examination is unremarkable, and vital signs are normal.  An hour after delivery, the newborn develops hypoglycemia.  Which of the following is most likely the cause of this patient's hypoglycemia?

A) Excessive fetal insulin production
B) Excessive maternal insulin doses
C) Fetal cortisol deficiency
D) Impaired fetal glucose production
E) Impaired fetal insulin-like growth factor 2 production
F) Inadequate fetal hepatic glycogen stores

Correct Answer:

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