Gestational & Pregestational Diabetes Management Flashcards

When should postpartum glucose testing be performed in women who had gestational diabetes, and which test is recommended?

Answer: 75g OGTT at 4-12 weeks postpartum (ideally 6-8 weeks)

ADA recommends a 75g OGTT at 4-12 weeks postpartum to screen for persistent dysglycemia; HbA1c is less sensitive early postpartum due to hematologic changes from delivery.

What is the approximate lifetime risk of developing type 2 diabetes in women with a history of gestational diabetes?

Answer: Up to 50-70% over their lifetime

Women with prior GDM have up to 50-70% lifetime risk of developing type 2 diabetes, making ongoing surveillance and preventive intervention critically important.

Which intervention has the strongest evidence for preventing or delaying progression from prediabetes (in women with prior GDM) to type 2 diabetes?

Answer: Intensive lifestyle intervention achieving 5-7% weight loss through diet and exercise

The Diabetes Prevention Program demonstrated that intensive lifestyle intervention (5-7% weight loss, 150 min/week physical activity) reduced T2DM progression by 58% in high-risk individuals, outperforming metformin.

Women with pregestational type 1 diabetes planning pregnancy should be counseled that which microvascular complication may worsen during pregnancy?

Answer: Diabetic retinopathy, particularly with rapid early-pregnancy glycemic improvement

Diabetic retinopathy can paradoxically worsen when glycemic control improves rapidly at the start of pregnancy; preconception ophthalmologic evaluation and trimester-by-trimester monitoring are recommended.

What HbA1c target is recommended prior to conception in women with pregestational diabetes to minimize congenital malformation risk?

Answer: Less than 6.5% if achievable without significant hypoglycemia risk

ADA recommends preconception HbA1c <6.5% if achievable without excessive hypoglycemia, as congenital malformation risk rises with HbA1c above this threshold during organogenesis.

Which long-acting insulin has the most established pregnancy safety data and is preferred for basal coverage in pregnant women with type 1 or type 2 diabetes?

Answer: Insulin detemir (Levemir), which has the most pregnancy-specific clinical trial data

Insulin detemir has been studied in randomized controlled trials during pregnancy and carries an FDA Pregnancy Category B designation, making it the preferred long-acting analog in pregnant women with diabetes.

After delivering her infant, a woman with type 1 diabetes should expect her insulin requirements to:

Answer: Decrease by 50% or more as placental insulin resistance resolves rapidly

Delivery eliminates placental hormones that drove insulin resistance, causing a rapid 50%+ drop in insulin requirements; failure to reduce doses promptly poses significant maternal hypoglycemia risk.