Newborns of mothers with diabetes are at high risk of hypoglycemia due to chronic fetal hyperinsulinemia. Maternal hyperglycemia leads to increased glucose transfer across the placenta, stimulating the fetal pancreas to produce excess insulin. After birth, the sudden loss of maternal glucose supply combined with persistent high insulin levels causes rapid hypoglycemia. This is a key metabolic adaptation issue unique to infants of diabetic mothers. Recognizing this mechanism is crucial for early detection and management of neonatal hypoglycemia.

Reference: Nelson Textbook of Pediatrics, Kliegman, 21st Edition.