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Dr.Niraj Mahajan
Dr.Niraj Mahajan
Dr.Niraj Mahajan


Gestational Diabetes

By AdminPosted On 05-Oct-2016

1. Screening for Gestational Diabetes

The best screening test for gestational diabetes

a) Fasting blood sugar

b) Random blood sugar

c) Glucose challenge test

d) Glucose tolerance test

e) Blood sugar series

Correct Answer: c and d. (d) with 75 gm glucose. There is uncertainty as to the optimal approach for screening and diagnosis of GDM. RCOG (2010) and WHO (2013) recommends a one-step 75 g oral glucose tolerance test for all women not already known to be diabetic at 24–28 weeks of gestation. ACOG (2013) recommends 2-step approach to testing is based on first screening with the administration of 50 g of an oral glucose solution followed by a 1-hour venous glucose determination. Those women meeting or exceeding the screening threshold undergo a 100-g, 3-hour diagnostic oral glucose tolerance test (OGTT).

2. Diabetes in pregnancy

Which of the followings is a known complication of diabetes in pregnancy?

a) Fetal microsomia

b) Oligohydramnios.

c) Iron deficiency anemia.

d) Fungal infection.

e) Placenta previa.

Correct Answer: d) Fungal infection. Fungal infections in patients with diabetes are very often caused by the yeast-like fungus called Candida Albicans. Elevated blood sugars appear in the mucus of the vagina and vulva, so they serve as an excellent culture medium for yeast.

3. Gestational Diabetes

During pregnancy, blood tests for diabetes are more abnormal than in nonpregnant state. This is due to :

a) Decreased insulin.

b) Increased absorption from the GI tract.

c) Increased placental lactogen.

d) Estrogen decreases and progesterone increases.

e) Hemoconcentration.

Correct Answer: c) Increased placental lactogen. Gestational diabetes is caused when insulin receptors do not function properly. This is likely due to pregnancy-related factors such as the presence of human placental lactogen that interferes with susceptible insulin receptors. This in turn causes inappropriately elevated blood sugar levels.

4. Pregnancy Glucose

Normally, pregnancy in 2ND trimester is characterized by all of the following EXCEPT:

a) Elevated fasting plasma glucose.

b) Decreased fasting plasma glucose.

c) Elevated postprandial plasma insulin.

d) Elevated postprandial plasma glucose.

e) Elevated plasma triglycerides.

Correct Answer: a) Elevated fasting plasma glucose. Pregnancy is potentially diabetogenic. Normal pregnancy is characterised by fasting hypoglycemia, postprandial hyperglycemia and hyperinsulinemia.

5. Human Placental Lactogen

The peripheral tissue resistance to insulin in pregnant women is mediated by:

a) Human chorionic gonadotropin.

b) Human placental lactogen.

c) Growth hormone.

d) Luteinizing hormone.

e) Follicle stimulating hormone.

f) Estrogen.

g) Progesterone.

Correct Answer: b) Human placental lactogen. It modifies the metabolic state of the mother during pregnancy to facilitate the energy supply of the fetus. hPL has anti-insulin properties.

6. Polyhydramnios in Gestational Diabetes

Polyhydramnios is associated with the following condition

a) Intrauterine growth restriction

b) Fetal kidney agenesis

c) Diabetes insipidus

d) Tracheo oesophageal fistula

e) Hind water leakage

Correct Answer: d and c. Tracheo oesophageal fistula impair the ability of the fetus to swallow. Maternal diabetes insipidus of pregnancy from excessive secretion of placental vasopressinase resulting in fetal polyuria. If the fetus has inherited diabetes insipidus, then they end up producing excessive amounts of urine causing polyhydramnios.

7. Glucose tolerance test

a) Is used as a screening test for diabetes.

b) Is considered to be a diagnostic test for diabetes.

c) Is performed in a non-fasting state.

d) Should be avoided during pregnancy as it needs a loading dose of glucose.

e) 50 mg of glucose should be given to the patient.

Correct Answer: b) Is considered to be a diagnostic test for diabetes.

8. HbA1C

HbA1C is a marker of diabetic control over what time period?

a) 48 hours

b) Up to 1 week

c) 4–8 weeks

d) 8–10 weeks

e) 10–12 weeks

Correct Answer: d) 8–10 weeks. Measurement of HbA1c is an indicator of glycaemic control over the previous 8–10 weeks, and is used to monitor patients with type I diabetes. It should not be used as a diagnostic test for type I diabetes.

9. Target levels of HbA1C

Pregnant woman with diabetes mellitus, target levels of HbA1C should be below what level?

a) 4.1 %

b) 6.1%

c) 8.1%

d) 10.1%

e) 12.1%

Correct Answer: b) 6.1%. Diabetic women should be managed by a specialised multidisciplinary team. There should be an increased frequency of self monitoring and monthly checks of HbA1c levels. The aim is to achieve optimum control with the levels of HbA1c below 6.1%. Maternal and fetal risks are reduced with decreasing HbA1c levels. However, rapid reduction is not advisable. If the levels are above 10%, pregnancy is not recommended.

10. Diabetes Mellitus in Pregnancy

A 4.3 kg infant is delivered to a woman whose diabetes mellitus is poorly controlled. Of the following, the MOST likely neonatal manifestation of maternal diabetes is

a) Diabetic ketoacidosis

b) Hirschsprung disease

c) Hypercalcemia

d) Polycythemia

e) Renal vein thrombosis

Correct Answer: d) Polycythemia. Infants born to mothers with glucose intolerance are at an increased risk of morbidity and mortality related to the following:

1. Respiratory distress

2. Growth abnormalities

3. Hyperviscosity secondary to polycythemia

4. Hypoglycemia

5. Congenital malformations

6. Hypocalcemia, hypomagnesemia, and iron abnormalities

11. Gestational Diabetes Patient

33-year-old P3L3 had gestational diabetes during the last two pregnancies. She takes no medications. Family history is significant for paternal coronary artery disease. Physical examination is unremarkable. Which of the following interventions should this woman most likely have?

a) Chest x-ray every 3 years

b) Coronary angiography every 3 years

c) Fasting glucose testing every 3 years

d) Mammography every 3 years

e) Pap testing every 3 years

Correct Answer: c) Fasting glucose testing every 3 years

Patients with a history of gestational diabetes have a high likelihood for eventually developing overt diabetes. These women should therefore be extensively counseled regarding the importance of diet and exercise. Along with counseling, testing is necessary to determine which patients actually do develop overt diabetes.

12. Diabetes planning Pregnancy

A 25-year-old woman with a history of type I diabetes, attends the preconception clinic. What pharmacological advice should be offered?

a) Commence ACE inhibitors

b) Commence an oral hypoglycaemic agent

c) Commence folic acid

d) Commence statins

e) Reduce the dose of insulin

Correct Answer: c) Commence folic acid. Folic acid is essential for the prevention of neural tube defects. Women with type I diabetes are at high risk of developing neural tube defects. Folic acid should be prescribed at a dose of 5 mg per day in high-risk groups for Diabetes planning Pregnancy. Other high-risk group patients include women with previously affected children and women on antiepileptic drugs. Insulin is the drug of choice for the patient described above and in most cases, the dosage would not be required to be reduced for Diabetes planning Pregnancy.

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Dr. Niraj Mahajan

MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.

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