Maternal Hypoglycemia with Large Uterine Fibroid and Paradoxical Fetal Overgrowth: Plausible Mechanisms
https://doi.org/10.15605/jafes.041.S1
- Author:
Jayaseelan Sekaran
1
;
Vickneswaran Marathamuthu
1
;
Ooi Chuan Ng
2
Author Information
1. Hospital Sultan Abdul Aziz Shah
2. Universiti Putra Malaysia
- Publication Type:Journal Article
- MeSH:
Diabetes, Gestational;
Fetal Macrosomia;
Leiomyoma;
Hypoglycemia
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):68-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Uterine fibroids are common in reproductive-age women
and are associated with obstetric complications. Their
potential contribution to maternal metabolic disturbances is
poorly described. We report a case of maternal hypoglycemia
in the setting of a large uterine fibroid and fetal overgrowth,
suggesting a possible endocrine–metabolic interaction.
Case:A 39-year-old multiparous female with no history of
diabetes or endocrine disease had a large lower-segment
uterine fibroid measuring 8 × 10 cm. Pregnancy was otherwise uncomplicated until 39 weeks, when she underwent
classical Caesarean section for transverse lie and delivered
a large-for-gestational-age infant.
Postpartum, she developed recurrent symptomatic hypoglycemia despite normal hemoglobin A1c (5.0%) and preserved thyroid and adrenal function. There was no evidence
of sepsis, liver disease, medication exposure, or insulinoma.
Hypoglycemia resolved spontaneously following delivery.
Postnatal imaging showed persistence of the fibroid (6 ×
9 cm). She remains under follow-up, considering interval
laparoscopic myomectomy with bilateral tubal ligation.
The coexistence of maternal hypoglycemia and fetal
overgrowth raises the possibility of altered maternal–
fetal glucose dynamics. Large mesenchymal tumors may
produce insulin-like growth factor 2 (IGF-2), causing
non–islet cell tumor hypoglycemia. Fibroid-related uteroplacental hemodynamic changes or increased fetal glucose
demand may also contribute. While causality cannot be
established, the temporal resolution post-delivery suggests
a contributory role of the fibroid in metabolic disturbance.
Conclusion:This case highlights a rare but clinically relevant association between a large uterine fibroid, maternal hypoglycemia, and fetal overgrowth. In pregnant patients with
unexplained hypoglycemia, uterine fibroids may represent
an overlooked factor. Multidisciplinary follow-up and
further research into IGF signaling and placental–tumor
interactions are warranted.
- Full text:202608031700142416EP_A089.pdf
