BC ADM Gestational & Pregestational Diabetes Management 3

Question 1

When should postpartum glucose testing be performed in women who had gestational diabetes, and which test is recommended?

Accepted Answer

75g OGTT at 4-12 weeks postpartum (ideally 6-8 weeks)

Answer

Fasting glucose only at 6 months postpartum

Answer

HbA1c at hospital discharge before leaving

Answer

Random glucose at the 12-month annual visit

Question 2

What is the approximate lifetime risk of developing type 2 diabetes in women with a history of gestational diabetes?

Accepted Answer

Up to 50-70% over their lifetime

Answer

Approximately 5-10% lifetime risk, similar to the general population

Answer

Approximately 20-30% over 10 years

Answer

Less than 5% lifetime risk with successful lifestyle modification

Question 3

Which intervention has the strongest evidence for preventing or delaying progression from prediabetes (in women with prior GDM) to type 2 diabetes?

Accepted Answer

Intensive lifestyle intervention achieving 5-7% weight loss through diet and exercise

Answer

Immediate preventive metformin therapy initiated at postpartum visit

Answer

Annual HbA1c monitoring with treatment only upon T2DM diagnosis

Answer

Bariatric surgery referral for all women with BMI >30 kg/m²

Question 4

Women with pregestational type 1 diabetes planning pregnancy should be counseled that which microvascular complication may worsen during pregnancy?

Accepted Answer

Diabetic retinopathy, particularly with rapid early-pregnancy glycemic improvement

Answer

Peripheral neuropathy, which worsens due to fluid shifts

Answer

Nephropathy, which accelerates due to increased GFR

Answer

Autonomic neuropathy, which causes preeclampsia

Question 5

What HbA1c target is recommended prior to conception in women with pregestational diabetes to minimize congenital malformation risk?

Accepted Answer

Less than 6.5% if achievable without significant hypoglycemia risk

Answer

Less than 8.0%, balancing maternal safety with fetal risk

Answer

Less than 7.0%, consistent with general diabetes management goals

Answer

Less than 6.0% regardless of hypoglycemia risk

Question 6

Which long-acting insulin has the most established pregnancy safety data and is preferred for basal coverage in pregnant women with type 1 or type 2 diabetes?

Accepted Answer

Insulin detemir (Levemir), which has the most pregnancy-specific clinical trial data

Answer

Insulin glargine U-300 (Toujeo) due to its flat pharmacokinetic profile

Answer

Insulin degludec (Tresiba) due to its ultra-long duration of action

Answer

NPH insulin exclusively, as no analogs are approved in pregnancy

Question 7

After delivering her infant, a woman with type 1 diabetes should expect her insulin requirements to:

Accepted Answer

Decrease by 50% or more as placental insulin resistance resolves rapidly

Answer

Remain at approximately the same level as her third-trimester doses for the first postpartum week

Answer

Increase by approximately 25% due to postpartum stress response

Answer

Fluctuate unpredictably for up to 6 months postpartum