Glucose EAQs Practice Test 2026 – Your Comprehensive All-in-One Guide for Exam Mastery!

A key idea is that respiratory distress syndrome in newborns mainly stems from a lack of surfactant, which helps keep the tiny air sacs open at the end of each breath. Surfactant production ramps up late in pregnancy under the influence of stress hormones like cortisol. When the mother has Type 1 diabetes, the fetus often has higher insulin levels (fetal hyperinsulinemia), which can blunt the effect of cortisol and delay maturation of the lungs and surfactant production. This means a baby born to a mother with diabetes is at increased risk for RDS—even if gestational age isn’t very premature.

As a result, you’d expect signs of respiratory distress soon after birth—rapid and labored breathing, grunting, nasal flaring, chest retractions, and observable cyanosis—because the immature lungs aren’t efficiently keeping the airways open. This is why infants of diabetic mothers require close respiratory monitoring after birth and may need interventions such as surfactant therapy or supportive ventilation if RDS develops. Prematurity is also a risk factor for RDS, but the diabetes-related mechanism directly explains the increased risk even when the baby isn’t extremely premature.