BC ADM Gestational & Pregestational Diabetes Management 4 — Questions and Answers
Question 1: A woman with pregestational type 1 diabetes is planning pregnancy. Which HbA1c target is recommended prior to conception to minimize congenital anomaly risk?
- Less than 6.5% (48 mmol/mol) (Correct answer)
- Less than 7.0% (53 mmol/mol)
- Less than 8.0% (64 mmol/mol)
- Less than 9.0% (75 mmol/mol)
Correct answer: Less than 6.5% (48 mmol/mol)
Preconception HbA1c <6.5% is recommended to minimize the risk of congenital malformations, as anomalies primarily develop in the first trimester.
Question 2: Which maternal complication is most strongly associated with uncontrolled pregestational diabetes during the first trimester?
- Polyhydramnios
- Congenital anomalies (Correct answer)
- Macrosomia
- Preterm labor
Correct answer: Congenital anomalies
Congenital anomalies are most strongly linked to hyperglycemia during organogenesis in the first trimester, when pregestational diabetes is established.
Question 3: A patient with GDM at 34 weeks has a nonstress test showing repetitive late decelerations. The most appropriate next step is:
- Continue outpatient monitoring and repeat NST in one week
- Initiate insulin therapy if not already started
- Proceed to delivery or further evaluation with biophysical profile (Correct answer)
- Increase dietary carbohydrate restriction
Correct answer: Proceed to delivery or further evaluation with biophysical profile
Repetitive late decelerations indicate uteroplacental insufficiency and require urgent further evaluation (BPP) or delivery rather than watchful waiting.
Question 4: Diabetic ketoacidosis (DKA) in pregnancy is most dangerous because it can occur at a blood glucose level as low as:
- 400 mg/dL
- 300 mg/dL
- 250 mg/dL
- 180 mg/dL (Correct answer)
Correct answer: 180 mg/dL
Pregnancy lowers the threshold for DKA; euglycemic DKA can occur at glucose levels as low as 180 mg/dL due to altered metabolism and increased ketogenesis.
Question 5: When counseling a woman with GDM about breastfeeding, which benefit should be emphasized?
- Breastfeeding eliminates the risk of type 2 diabetes in all mothers
- Lactation improves neonatal lung maturity
- Breastfeeding is associated with reduced risk of type 2 diabetes in the mother and offspring (Correct answer)
- Breastfeeding normalizes maternal HbA1c within 6 weeks postpartum
Correct answer: Breastfeeding is associated with reduced risk of type 2 diabetes in the mother and offspring
Breastfeeding is associated with lower long-term risk of type 2 diabetes for both the mother who had GDM and her child.
Question 6: A woman with pregestational type 2 diabetes is switched from oral agents to insulin at conception. Which oral agent is sometimes continued or used in pregnancy as an alternative to insulin?
- Glipizide
- Metformin (Correct answer)
- Sitagliptin
- Canagliflozin
Correct answer: Metformin
Metformin is sometimes continued or used in pregnancy for type 2 diabetes, though it crosses the placenta; evidence of safety is growing but insulin remains the standard of care.
Question 7: In a neonate born to a mother with poorly controlled diabetes, which metabolic complication should be anticipated and monitored for in the first hours after birth?
- Hyperglycemia
- Hyperkalemia
- Neonatal hypoglycemia (Correct answer)
- Metabolic alkalosis
Correct answer: Neonatal hypoglycemia
Neonatal hypoglycemia occurs because fetal hyperinsulinism persists after birth once the maternal glucose supply is cut off at delivery.
BC ADM Gestational & Pregestational Diabetes Management 4
A woman with pregestational type 1 diabetes is planning pregnancy.
Which HbA1c target is recommended prior to conception to minimize congenital anomaly risk?