Obstetric Nurse High-Risk Pregnancy Management Flashcards

A patient's 1-hour glucose challenge test (GCT) result is 152 mg/dL. What is the appropriate next step?

Answer: Perform a 3-hour 100g oral glucose tolerance test (OGTT)

A 1-hour GCT result ≥140 mg/dL (some use ≥130 mg/dL) is abnormal and requires a diagnostic 3-hour 100g OGTT to confirm or rule out gestational diabetes.

What is the fasting blood glucose target for a patient with gestational diabetes managed with diet and exercise?

Answer: Less than 95 mg/dL

ACOG recommends a fasting glucose target of less than 95 mg/dL for women with gestational diabetes to reduce the risk of macrosomia and perinatal complications.

A neonate born to a mother with poorly controlled gestational diabetes is at highest immediate risk for which complication?

Answer: Neonatal hypoglycemia

Maternal hyperglycemia causes fetal hyperinsulinemia; after delivery and removal of the maternal glucose source, the elevated insulin causes neonatal hypoglycemia.

Macrosomia in infants of mothers with gestational diabetes is primarily caused by:

Answer: Fetal hyperinsulinemia secondary to maternal hyperglycemia

Maternal glucose crosses the placenta, stimulating the fetal pancreas to produce excess insulin, which acts as a growth factor and results in macrosomia.

Which insulin type is traditionally preferred for use during pregnancy due to its established safety profile?

Answer: NPH and regular human insulin

NPH and regular human insulin have the longest safety records in pregnancy; however, insulin lispro and detemir are also considered acceptable per recent guidelines.

A patient with gestational diabetes whose blood glucose normalized during delivery should be scheduled for which postpartum test?

Answer: 75g OGTT at 6–12 weeks postpartum

ACOG recommends a 75g 2-hour OGTT at 6–12 weeks postpartum to screen for persistent glucose intolerance or type 2 diabetes, as GDM significantly increases long-term risk.