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.
Diabetes, Gestational ; Fetal Macrosomia ; Leiomyoma ; Hypoglycemia