Question

A 30-year-old lady G2P1L1 at 14 weeks, with a history of GDM in the first pregnancy, comes for antenatal care.

Hint:

Early screening is recommended for women with a history of GDM, as they are at higher risk of recurrence in subsequent pregnancies.

Answer 1

Step 1: Diagnosis of Gestational Diabetes Mellitus (GDM).
Gestational Diabetes Mellitus (GDM) is diagnosed through screening and confirmatory tests during pregnancy. The general approach includes:
(1) Risk Assessment:
- In this case, the patient has a history of GDM in her first pregnancy, which makes her high risk for developing GDM again.
(2) Screening for GDM:
- Oral Glucose Tolerance Test (OGTT): The gold standard for diagnosing GDM. A 75g OGTT is usually performed at 24-28 weeks of gestation, but for high-risk patients, earlier screening may be done.
- Procedure for OGTT: The patient fasts overnight and then consumes a 75g glucose drink. Blood glucose levels are measured at fasting, 1 hour, and 2 hours post-consumption.
- Fasting glucose \(\ge\)92 mg/dL
- 1-hour glucose \(\ge\)180 mg/dL
- 2-hour glucose \(\ge\)153 mg/dL
(3) Alternative Approach:
- One-step and two-step approaches may vary by country or hospital guidelines. The one-step approach uses the 75g OGTT as a diagnostic test, while the two-step approach starts with a 50g glucose challenge test (GCT) at 24-28 weeks and follows up with a confirmatory 100g OGTT if the GCT is positive.