Obstetrics & Gynecology>>>>>The Puerperium, Lactation, and Immediate Care of the Newborn
Question 31#

A 35-year-old G2P2 presents for her routine postpartum visit. Her pregnancy was complicated by gestational diabetes, which was diagnosed in the second trimester during routine screening. She has no other medical problems, and she has no family history of diabetes. She gained 25 pounds during her pregnancy, and her gestational diabetes was managed with diet modification. 

How should this patient be managed postpartum?

A) She should have a fasting glucose on postpartum day 1, and if normal, no other evaluation is needed
B) She should have a glucose tolerance test performed on postpartum day 1
C) She should have a glucose tolerance test performed 6 to 12 weeks’ postpartum
D) She should be referred back to her primary care provider for further evaluation
E) . She does not need any further evaluation

Correct Answer is C

Comment:

It is estimated that 15% to 50% of women with gestational diabetes will develop type 2 diabetes later in life. Postpartum screening at 6 to 12 weeks is recommended to identify women with diabetes, impaired fasting glucose, or impaired glucose tolerance. Women with GDM have a sevenfold increased risk of developing type 2 diabetes when compared to women without GDM. Either a fasting plasma glucose or the 75-g oral glucose tolerance test may be ordered in the postpartum period. Offspring of mothers with gestational diabetes are at an increased risk for obesity later in life. There is some data that development of type 2 diabetes may be impacted by intrauterine exposure to hyperglycemia. Both types 1 and 2 diabetes have a large genetic component.