Gestational & Pregestational Diabetes Management Flashcards

A woman with GDM at 38 weeks has consistently normal fasting glucose but elevated 1-hour postmeal values. The most appropriate pharmacologic intervention is:

Answer: Rapid-acting insulin with meals

Isolated postprandial hyperglycemia in GDM is best treated with rapid-acting insulin at meals to blunt the postprandial glucose excursion.

Which finding on ultrasound most specifically indicates fetal hyperinsulinism secondary to maternal hyperglycemia?

Answer: Fetal abdominal circumference > 90th percentile

Excessive fetal abdominal circumference reflects hepatic and visceral fat deposition driven by fetal hyperinsulinism, a hallmark of diabetic fetopathy.

What is the recommended timing for the oral glucose tolerance test postpartum in women who had GDM?

Answer: 4–12 weeks postpartum with a 75g OGTT

ACOG and ADA recommend a 75g, 2-hour OGTT at 4–12 weeks postpartum to screen for persistent glucose intolerance or type 2 diabetes.

A pregnant woman with type 1 diabetes reports increasing nocturnal hypoglycemia in the second trimester. The best adjustment to her insulin regimen is:

Answer: Reduce basal insulin dose and increase bedtime snack if needed

Reducing the basal insulin dose targets nocturnal hypoglycemia, and a small bedtime snack can stabilize overnight glucose without causing daytime hyperglycemia.

Which condition is a contraindication to expectant management beyond 39 weeks in a woman with well-controlled GDM on diet alone?

Answer: Suspected macrosomia with estimated fetal weight >4,500 g

Estimated fetal weight >4,500 g in a diabetic patient raises the risk of shoulder dystocia and brachial plexus injury, prompting earlier delivery or cesarean consideration.

During labor in a woman with pregestational diabetes on insulin, intravenous glucose and insulin infusions are adjusted to maintain maternal blood glucose at:

Answer: 80–110 mg/dL

Maintaining intrapartum maternal glucose between 80–110 mg/dL minimizes the risk of neonatal hypoglycemia immediately after birth.

A woman previously diagnosed with GDM is now 3 years postpartum with a normal fasting glucose. How often should she be rescreened for prediabetes or type 2 diabetes?

Answer: Every 1–2 years

Women with a history of GDM have up to a 50% lifetime risk of type 2 diabetes and should be rescreened every 1–3 years, with most guidelines recommending every 1–2 years.