A 28-year-old woman delivered a 9.5 lb infant. The infant was above the 95th percentile for weight and length. The mother’s history was incomplete; she claimed to have had no medical care through her pregnancy. Shortly after birth, the infant became lethargic and flaccid. A whole blood glucose and ionized calcium were performed in the nursery with the following results: Whole blood glucose: 25 mg/dL
Ionized calcium: 4.9mEq/L
Plasma glucose was drawn and analyzed in the main lab to confirm the whole blood findings.
Plasma glucose: 33 mg/dL
An intravenous glucose solution was started and whole blood glucose was measured hourly.
1. Give the possible explanation for the infant’s large birth weight and size.
2. If the mother was a gestational diabetic, why was her baby hypoglycemic?
3. Why was there a discrepancy between the whole blood glucose concentration and the plasma glucose concentration?4. If the mother had been monitored during pregnancy, what lab tests should have been performed and what criteria would have indicated that she had gestational diabetes?