**Question:** A 26-year-old gravida 3 woman has a history of gestational diabetes and a delivery of two previous infants at term that were greater than 4000 grams, each of whom had severe hypoglycemia. Which of the following maneuvers is least likely to reduce the chance of the next child's having hypoglycemia?

A. Reducing maternal weight loss after delivery
B. Increasing maternal exercise
C. Using antenatal corticosteroids to stimulate fetal lung maturity
D. Monitoring maternal blood glucose levels more frequently during pregnancy

**Correct Answer:** A. Reducing maternal weight loss after delivery

**Core Concept:** Gestational diabetes mellitus (GDM) is a type of diabetes that develops during pregnancy. In this case, the patient has a history of gestational diabetes and delivered two infants with severe hypoglycemia due to their large size and prematurity. Maternal interventions for reducing the risk of hypoglycemia in future pregnancies are essential.

**Why the Correct Answer is Right:** Maternal weight loss after delivery is not directly related to fetal growth or hypoglycemia risk. Although weight loss is a common postpartum process, it does not influence fetal size or glycemic control in the mother, which are primary factors contributing to the risk of hypoglycemia in infants born to mothers with GDM.

**Why Each Wrong Option is Incorrect:**

B. Increasing maternal exercise: While exercise is beneficial for maternal health, it does not directly address fetal growth or hypoglycemia risk. Improving maternal glucose control is essential for reducing the risk of hypoglycemia in infants.

C. Using antenatal corticosteroids to stimulate fetal lung maturity: This intervention is aimed at improving fetal lung maturity, which may reduce respiratory distress syndrome but does not directly address fetal size or glycemic control.

D. Monitoring maternal blood glucose levels more frequently during pregnancy: Monitoring glucose levels is important for managing GDM and improving maternal glycemic control, which indirectly affects fetal size and hypoglycemia risk. However, focusing solely on frequent glucose monitoring does not specifically target fetal size, unlike the correct answer (A) that addresses maternal weight loss after delivery.

**Clinical Pearls:**

In the context of GDM, addressing maternal weight loss after delivery is essential to reduce the risk of hypoglycemia in infants. This is because maternal weight loss contributes to a decrease in placental mass, leading to improved placental function and better glucose transport to the fetus. Improved placental function can result in smaller infants, reducing the risk of hypoglycemia in the neonatal period. Additionally, addressing maternal weight loss after delivery helps to prevent gestational weight gain in future pregnancies, which can reduce the risk of macrosomia (large infants) and its associated complications, such as hypoglycemia in the newborn.

✓ Correct Answer: B. Maternal intravenous loading with 10% glucose beginning 2 to 4 h prior to the expected time of delivery