BC ADM Gestational & Pregestational Diabetes Management 5 — Questions and Answers
Question 1: A woman with GDM at 38 weeks has consistently normal fasting glucose but elevated 1-hour postmeal values. The most appropriate pharmacologic intervention is:
- Basal insulin at bedtime
- Rapid-acting insulin with meals (Correct answer)
- Metformin twice daily
- Glyburide at bedtime
Correct 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.
Question 2: Which finding on ultrasound most specifically indicates fetal hyperinsulinism secondary to maternal hyperglycemia?
- Ventriculomegaly
- Fetal abdominal circumference > 90th percentile (Correct answer)
- Choroid plexus cysts
- Decreased femur length
Correct 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.
Question 3: What is the recommended timing for the oral glucose tolerance test postpartum in women who had GDM?
- 2 weeks postpartum with a 50g GCT
- 4–12 weeks postpartum with a 75g OGTT (Correct answer)
- 6 months postpartum with fasting glucose only
- One year postpartum with HbA1c only
Correct 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.
Question 4: A pregnant woman with type 1 diabetes reports increasing nocturnal hypoglycemia in the second trimester. The best adjustment to her insulin regimen is:
- Reduce total daily dose by 50%
- Reduce basal insulin dose and increase bedtime snack if needed (Correct answer)
- Discontinue basal insulin and use only rapid-acting insulin
- Add glucagon-like peptide-1 agonist therapy
Correct 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.
Question 5: Which condition is a contraindication to expectant management beyond 39 weeks in a woman with well-controlled GDM on diet alone?
- Estimated fetal weight of 3,200 g
- Prior cesarean delivery
- Suspected macrosomia with estimated fetal weight >4,500 g (Correct answer)
- Maternal age over 35
Correct 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.
Question 6: During labor in a woman with pregestational diabetes on insulin, intravenous glucose and insulin infusions are adjusted to maintain maternal blood glucose at:
- 60–80 mg/dL
- 80–110 mg/dL (Correct answer)
- 140–180 mg/dL
- 180–200 mg/dL
Correct answer: 80–110 mg/dL
Maintaining intrapartum maternal glucose between 80–110 mg/dL minimizes the risk of neonatal hypoglycemia immediately after birth.
Question 7: 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?
- Only if symptoms develop
- Every 1–2 years (Correct answer)
- Every 3 years
- Every 5 years
Correct 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.
BC ADM Gestational & Pregestational Diabetes Management 5
A woman with GDM at 38 weeks has consistently normal fasting glucose but elevated 1-hour postmeal values.
The most appropriate pharmacologic intervention is: