Deck 33: Gestational Diabetes Mellitus

Question 1

Normal pregnancy, without diabetes, is characterized by progressive insulin resistance, maternal hyperinsulinemia, and mild postprandial hyperglycemia.

Answer 1

True

Question 2

Which of the following placental hormones has the greatest effect of increasing insulin resistance:

A) Cortisol
B) Estrogen
C) Human placental lactogen (hPL)
D) Progesterone
E) Tumor necrotizing factor (TNFα)

Answer 2

E

Question 3

Gestational diabetes is not associated with which of the following:

A) Cesarean birth
B) Fetal macrosomia
C) Hyperglycemia in the newborn
D) Obesity in offspring

Answer 3

C

Question 4

B.C. is a 37-year-old G1 P0 at 8 weeks gestation with a BMI of 25 and no known family history of diabetes. She is of Southeast Asian descent. According to American Diabetes Association/American College of Obstetricians and Gynecologists guidelines should she be screened now for GDM?

A) Yes
B) No

Question 5

R.S. underwent a one-step, 2-hour oral glucose tolerance test (OGTT) at 26 weeks. Which of the following results diagnose GDM?

A) 76mg/dL, 158mg/dL,102mg/dL
B) 87mg/dL, 130 mg/dL,145mg/dL
C) 91 mg/dL, 179mg/dL, 152mg/dL
D) 92mg/dL,165mg/dL, 151mg/dL
E) None of the above

Question 6

Healthy eating is the cornerstone of successful diabetes management. Which of the following does not constitute healthy eating during pregnancy with GDM?

A) Avoiding foods containing sugar in the food facts label
B) Cutting out carbohydrates
C) Maintaining weight gain within the Institute of Medicine recommendations.
D) Using the plate method for GDM

Question 7

L.L. has GDM and has been following the meal plan provided by the registered dietician and her fasting values have been 95mg/dL, 92mg/dL, 85 mg/dL, 99mg/dL 85 mg/dL, 86mg/dL, and 98mg/dL. Postmeal values are 142mg/dL; 146mg/dL; 149mg/dL,152C; 143mg/dL150mg/dL. What advice would you give her?

A) Restrict carbohydrates a little more
B) Start oral medication or insulin
C) Suggest eating fruit only at bedtime

Question 8

M.M. has GDMA1 and gets her blood glucose (BG) checked weekly at her clinic appointment. She wants to know why she also needs to check her BG four times every day. Which of the following is true regarding her question?

A) Maternal hyperglycemia is associated with preeclampsia, fetal macrosomia, and neonatal hyperglycemia.
B) Studies show that women who checked their BG four times daily by a home monitor had less macrosomia than women who had their BG checked weekly.
C) Checking BG four times daily prevents ketonuria and reflex hypoglycemia and improves food choices.
D) c and b

Question 9

Women with diabetes during pregnancy are at increased risk for depression and should be screened for depression and referred appropriately.

Question 10

S.R. has GDM. She loves to eat white rice with each meal but changed to brown rice and reduced her intake to one cup at dinner to keep her blood glucose in control. This is successful problem solving. What other strategies would exemplify successful problem solving?

A) Diluting her favorite juice with a little water
B) Having dessert only in the evening after taking her last BG
C) Recognizing low blood sugar and treating it (rule of 15) for future prevention
D) Walking for 10-15 minutes after each meal

Question 11

D.B. is 36 weeks pregnant and has GDMA1 and no other complications. She usually has one or two mildly elevated postprandial blood sugars each week. Which of the following would be a part of your management?

A) Await labor as you would a woman without GDM
B) Begin biweekly antenatal testing this week
C) Begin oral medication or insulin
D) Induce labor at 40 weeks

Question 12

M.M is currently 32 weeks pregnant and has GDM. She requires medication because her fasting blood glucose levels have been consistently elevated. She does not want the medicine to go to the baby. Which medication would you suggest?

A) Glyburide
B) Insulin
C) Metformin

Question 13

Evidence shows which of the following to reduce the risk of future diabetes for a woman who has GDM?

A) Annual diabetes test beginning at age 50
B) Breastfeeding for at least 6 months
C) Continuing medication in the postpartum period
D) Use of progesterone-only birth control methods

Question 14

Which of the following is true of women who have GDM?

A) About 5% will have overt diabetes when tested after pregnancy.
B) An interpregnancy interval of 24 months will prevent GDM in future pregnancies.
C) Approximately 25% will have prediabetes when tested after pregnancy.
D) If they take metformin they are unlikely to have GDM with their next pregnancy.

Question 15

In addition to assuming a healthy lifestyle, how can a woman with GDMA2 know if diabetes is in her future?

A) Avoid pregnancy in the future.
B) Get a 2-hour OGTT 6-12 weeks postpartum and every 1-3 years get checked for diabetes.
C) Start taking metformin postpartum.