Diabetes in Pregnancy — MCQs
A baby born at 34 weeks gestation weighs 3kg. Which of the following conditions is this child most likely to develop in the immediate postnatal period?
The following cost-effective investigations are routinely recommended in the screening of antenatal mothers, EXCEPT:
Which of the following is false regarding management of diabetes in pregnancy?
What is the most common fetal complication associated with gestational diabetes?
A 28-year-old female, gravida 2, para 1, presents to the antenatal clinic at 24 weeks for a routine check-up. Ultrasonography shows a normal fetus for gestational age at 24 weeks of gestation in a frank breech position, with no other abnormalities. What is the most appropriate next step in management?
A 3.8 kg baby of a diabetic mother developed seizures 32 hours after birth. The most probable cause would be?
A G1 P0 woman at 36 weeks presents with newly diagnosed gestational diabetes. What is the most appropriate initial management?
All of these cause hyperglycemia except:
Overt diabetes in pregnancy is defined as fasting blood glucose more than what value?
Consider the following statements regarding HCG : 1. HCG is a glycoprotein with two subunits α and β. 2. HCG levels reach the maximum between the 60th and 70th day in a normal pregnancy. 3. HCG is secreted by the syncytiotrophoblast. Which of the statements given above is/are correct ?
Diabetes in Pregnancy Indian Medical PG Practice Questions and MCQs
Question 1: A baby born at 34 weeks gestation weighs 3kg. Which of the following conditions is this child most likely to develop in the immediate postnatal period?
- A. APH
- B. Diabetes
- C. Anemia (Correct Answer)
- D. None of the options
Explanation: ***Anemia*** - Macrosomic babies (3kg at 34 weeks is **large for gestational age**) initially develop **polycythemia** due to chronic intrauterine hypoxia and increased erythropoiesis, but this is followed by rapid **hemolysis** and breakdown of excess red blood cells after birth, leading to anemia in the immediate postnatal period. - Among the given options, **anemia** is the most appropriate answer as it represents a recognized complication of LGA babies through the **polycythemia-hemolysis cycle**, even though **hypoglycemia** is statistically the most common immediate complication. *APH* - **Antepartum hemorrhage (APH)** is a maternal obstetric complication involving bleeding before delivery, not a condition that the baby itself develops or shows. - While APH can affect fetal growth and well-being, it is not a **neonatal condition** that the child would present with after birth. *Diabetes* - Although **maternal diabetes** is the most common cause of fetal macrosomia, the newborn does not develop diabetes itself in the immediate postnatal period. - Instead, these babies are at risk for **hypoglycemia**, **respiratory distress**, and **hyperbilirubinemia** due to fetal hyperinsulinemia, but not diabetes as a presenting condition. *None of the options* - This is incorrect because **anemia** is indeed a valid condition that macrosomic babies can develop through the described polycythemia-hemolysis mechanism. - While other complications like **hypoglycemia** and **birth trauma** are more common, anemia remains a recognized sequela among LGA babies in the immediate postnatal period.
Question 2: The following cost-effective investigations are routinely recommended in the screening of antenatal mothers, EXCEPT:
- A. Blood sugar levels for GDM
- B. VDRL for syphilis
- C. Urine analysis for bacteriuria
- D. Echocardiography for cardiac disease (Correct Answer)
Explanation: ***Echocardiography for cardiac disease*** - **Echocardiography** is not a *routinely recommended* screening investigation for all antenatal mothers due to its cost and the relatively low prevalence of significant congenital heart disease requiring universal screening. - It is typically performed only if there are **specific risk factors** or suspicious findings suggesting cardiac pathology. *Blood sugar levels for GDM* - Screening for **gestational diabetes mellitus (GDM)** with blood sugar levels (e.g., glucose challenge test) is routinely recommended due to the potential maternal and fetal complications if untreated. - GDM is a common condition that can be effectively managed with early diagnosis, making screening a **cost-effective** preventive measure. *VDRL for syphilis* - Screening for **syphilis** using tests like VDRL (Venereal Disease Research Laboratory) is a standard and *routinely recommended* antenatal investigation. - Early detection and treatment of syphilis in pregnant women prevent serious adverse outcomes such as **congenital syphilis**, which can cause severe fetal morbidity and mortality. *Urine analysis for bacteriuria* - **Urine analysis** for **asymptomatic bacteriuria** is routinely recommended during pregnancy because untreated bacteriuria can lead to pyelonephritis, preterm labor, and low birth weight. - It is a simple, **cost-effective** test with significant benefits for maternal and fetal health.
Question 3: Which of the following is false regarding management of diabetes in pregnancy?
- A. In active labor, if RBS <70 mg/dL, D5 is started at 100-150 ml/hr till the RBS is >70 mg/dL
- B. In a patient being planned for induction of labor, night dose of intermediate insulin is given as planned, and the morning dose is withheld
- C. Elective C-section has no role in reducing incidence of brachial plexus injury (Correct Answer)
- D. Capillary blood glucose monitoring levels are kept at fasting- 95 mg/dL; 1 hr postprandial- 140 mg/dL; 2 hrs postprandial- 120 mg/dL
Explanation: ***Elective C-section has no role in reducing incidence of brachial plexus injury*** - This statement is **false** because **elective C-section** can significantly reduce the incidence of **brachial plexus injury** (BPI), especially in cases of suspected fetal macrosomia. - While not universally recommended for all diabetic pregnancies, an elective C-section is considered when the estimated **fetal weight** is substantial or when there's a history of **shoulder dystocia** to prevent birth trauma. *In active labor, if RBS <70 mg/dL, D5 is started at 100-150 ml/hr till the RBS is >70 mg/dL* - This is a **correct** management strategy for **hypoglycemia in labor**. Maintaining stable blood glucose levels (above 70 mg/dL) is crucial to prevent adverse outcomes for both mother and fetus. - The administration of **D5 (dextrose 5% in water)** intravenous solution at a specific rate helps to quickly raise and maintain blood glucose levels. *In a patient being planned for induction of labor, night dose of intermediate insulin is given as planned, and the morning dose is withheld* - This is a common and generally **correct** practice for insulin management before **induction of labor**. The night dose of intermediate insulin helps maintain basal glucose levels overnight. - Withholding the morning dose prevents **hypoglycemia** during labor when food intake is restricted, and insulin sensitivity may increase. Glucose is then typically supplemented through IV fluids as needed. *Capillary blood glucose monitoring levels are kept at fasting- 95 mg/dL; 1 hr postprandial- 140 mg/dL; 2 hrs postprandial- 120 mg/dL* - These are the generally accepted and **correct** target blood glucose levels for **diabetes in pregnancy** (both pre-existing and gestational diabetes). - Achieving these targets is essential to minimize the risk of **fetal macrosomia**, **neonatal hypoglycemia**, and other adverse perinatal outcomes.
Question 4: What is the most common fetal complication associated with gestational diabetes?
- A. Only a small percentage of women with gestational diabetes develop overt diabetes.
- B. There is a risk of macrosomia in babies born to mothers with gestational diabetes. (Correct Answer)
- C. Gestational diabetes is usually diagnosed in the second or third trimester.
- D. Gestational diabetes can increase the risk of congenital malformations.
Explanation: ***There is a risk of macrosomia in babies born to mothers with gestational diabetes.*** - **Macrosomia** (birth weight >4000g or >90th percentile) is a common complication due to fetal exposure to high glucose levels, stimulating excessive growth. - Increased fetal insulin from maternal hyperglycemia promotes fat accumulation and growth, leading to **shoulder dystocia**, birth trauma, and increased risk of C-section. *Only a small percentage of women with gestational diabetes develop overt diabetes.* - A significant percentage, up to **50% of women** with gestational diabetes, will develop **type 2 diabetes** later in life, often within 5-10 years postpartum, making this statement incorrect. - This persistent risk highlights the importance of postpartum screening and lifestyle modifications for these women. *Gestational diabetes is usually diagnosed in the second or third trimester.* - While screening typically occurs between **24 and 28 weeks of gestation** (second trimester), this describes when it is diagnosed, not the *most common risk* associated with the condition itself. - Early screening may occur in the first trimester for high-risk individuals, but the general screening period is later in pregnancy. *Gestational diabetes can increase the risk of congenital malformations.* - **Congenital malformations** are primarily associated with **pre-existing diabetes** (type 1 or type 2 diabetes) in the mother during the **first trimester**, when organogenesis occurs. - Gestational diabetes, diagnosed later in pregnancy, primarily leads to complications related to **fetal growth** and metabolic issues, not structural malformations.
Question 5: A 28-year-old female, gravida 2, para 1, presents to the antenatal clinic at 24 weeks for a routine check-up. Ultrasonography shows a normal fetus for gestational age at 24 weeks of gestation in a frank breech position, with no other abnormalities. What is the most appropriate next step in management?
- A. Glucose challenge test with 50 gm of glucose (Correct Answer)
- B. ECV
- C. Immediate LSCS
- D. Culture for Neisseria gonorrhoeae and Chlamydia trachomatis
Explanation: ***Glucose challenge test with 50 gm of glucose*** - The patient is 24 weeks pregnant, and a **glucose challenge test** is routinely performed between **24 and 28 weeks of gestation** to screen for gestational diabetes. - This screening is appropriate irrespective of fetal presentation, as it addresses a common and treatable pregnancy complication. *Culture for Neisseria gonorrhoeae and Chlamydia trachomatis* - While screening for sexually transmitted infections (STIs) like **gonorrhea** and **chlamydia** is important during pregnancy, it is typically performed at the **first prenatal visit** or during the **third trimester** for high-risk patients. - There is no indication from the provided information (e.g., risk factors, symptoms) to warrant this specific test at 24 weeks over routine gestational diabetes screening. *ECV* - **External cephalic version (ECV)** is a procedure to change a breech baby to a head-down position, usually performed closer to term, often around **36-37 weeks of gestation**. - At 24 weeks, a **frank breech position** is common and many fetuses will spontaneously turn to a cephalic presentation before term, making ECV premature at this stage. *Immediate LSCS* - **Immediate lower segment cesarean section (LSCS)** is a major surgical procedure indicated for obstetrical emergencies or planned for specific conditions late in pregnancy. - A **frank breech position** at 24 weeks with no other abnormalities is a normal variant and does not necessitate immediate delivery; many fetuses will spontaneously turn.
Question 6: A 3.8 kg baby of a diabetic mother developed seizures 32 hours after birth. The most probable cause would be?
- A. Hypoglycemia
- B. Hypocalcemia (Correct Answer)
- C. Birth asphyxia
- D. Intraventricular hemorrhage
Explanation: ***Hypocalcemia*** - In infants of diabetic mothers (IDM), hypocalcemia typically presents at **24-72 hours of life**, making it the most probable cause of seizures at 32 hours. - The mechanism involves **functional hypoparathyroidism** secondary to maternal hyperparathyroidism and **hypomagnesemia**, which impairs parathyroid hormone secretion and action. - IDMs have increased metabolic demands and altered calcium homeostasis due to intrauterine metabolic disturbances. - **Timing is key**: The presentation at 32 hours strongly favors hypocalcemia over hypoglycemia in the differential diagnosis. *Hypoglycemia* - While hypoglycemia is indeed common in IDMs due to **fetal hyperinsulinemia**, it typically occurs much earlier—within the **first 2-24 hours of life** (peak at 1-3 hours). - By 32 hours, hypoglycemia would usually have been detected through routine monitoring or would have manifested earlier with symptoms. - Neonatal hypoglycemia causes seizures, but the **timing in this case makes it less likely** than hypocalcemia. *Birth asphyxia* - Birth asphyxia leads to hypoxic-ischemic encephalopathy with seizures typically presenting within the **first 12-24 hours**. - Would be accompanied by other neurological signs like hypotonia, altered consciousness, and poor feeding from birth. - No history suggesting birth complications is provided in the scenario. *Intraventricular hemorrhage* - IVH is primarily a complication of **prematurity**, particularly in very low birth weight infants. - This 3.8 kg baby is likely term or large-for-gestational-age, making IVH uncommon unless significant birth trauma occurred. - IVH presents with acute neurological deterioration, bulging fontanelle, and altered consciousness—not mentioned here.
Question 7: A G1 P0 woman at 36 weeks presents with newly diagnosed gestational diabetes. What is the most appropriate initial management?
- A. Induction of labor
- B. Oral hypoglycemics
- C. Diet control (Correct Answer)
- D. Insulin
Explanation: ***Diet control (Medical Nutrition Therapy)*** - For newly diagnosed gestational diabetes, **lifestyle modifications**, primarily **dietary changes**, are the **first-line treatment** per ACOG and ADA guidelines - Medical nutrition therapy (MNT) aims to control blood glucose levels through proper nutrition and should be attempted for **1-2 weeks** before considering pharmacologic interventions - Target goals: Fasting glucose <95 mg/dL, 1-hour postprandial <140 mg/dL, 2-hour postprandial <120 mg/dL *Induction of labor* - **Induction of labor** is typically considered for gestational diabetes if there are concerns about **fetal macrosomia** (EFW >4000-4500g), **poor glycemic control despite treatment**, or other maternal-fetal complications - Generally considered at **39-40 weeks** in well-controlled GDM or earlier with complications - Not the initial management for a new diagnosis at 36 weeks without additional concerning features *Oral hypoglycemics* - **Metformin** or **glyburide** may be used as second-line agents when **dietary management fails** to achieve adequate glycemic control after 1-2 weeks - Metformin is increasingly preferred as it does not cross the placenta as readily as glyburide - They are **not the initial step** in management *Insulin* - **Insulin therapy** is indicated when **dietary modifications alone** are insufficient in maintaining target blood glucose levels - Also preferred if oral agents are contraindicated or fail to achieve glycemic targets - Represents a **secondary intervention** when primary non-pharmacological methods are inadequate
Question 8: All of these cause hyperglycemia except:
- A. Catecholamines
- B. Insulin (Correct Answer)
- C. Cortisol
- D. GH
Explanation: ***Insulin*** - Insulin's primary function is to **lower blood glucose levels** by facilitating glucose uptake into cells and promoting glycogen synthesis. - It counters the effects of hormones that elevate blood sugar, directly leading to a **decrease in hyperglycemia**. *Catecholamines* - **Catecholamines** (e.g., epinephrine, norepinephrine) increase blood glucose by promoting **glycogenolysis** and **gluconeogenesis**. - They also **inhibit insulin secretion**, further contributing to elevated blood sugar. *Cortisol* - **Cortisol** is a **glucocorticoid** that raises blood glucose by increasing **gluconeogenesis** and reducing peripheral **glucose utilization**. - It can also decrease insulin sensitivity, leading to **hyperglycemia**. *GH* - **Growth hormone (GH)** can induce **insulin resistance** in peripheral tissues, which leads to reduced glucose uptake. - It also promotes **gluconeogenesis**, both contributing to elevated blood glucose levels.
Question 9: Overt diabetes in pregnancy is defined as fasting blood glucose more than what value?
- A. ≥200 mg/dl
- B. ≥100 mg/dl
- C. ≥180 mg/dl
- D. ≥126 mg/dl (Correct Answer)
Explanation: ***≥126 mg/dl*** - A fasting plasma glucose level of **126 mg/dL or higher** is diagnostic of diabetes in the general population, which applies to overt diabetes in pregnancy. - This threshold indicates significant **hyperglycemia** and requires immediate management to prevent maternal and fetal complications. *≥200 mg/dl* - A fasting glucose level **≥200 mg/dL** is indicative of severe hyperglycemia, but the diagnostic threshold for diabetes is lower, at 126 mg/dL. - While this value would certainly confirm diabetes, it is not the *minimum* threshold for diagnosis. *≥100 mg/dl* - A fasting glucose level between **100 mg/dL and 125 mg/dL** is categorized as **impaired fasting glucose** (prediabetes), not overt diabetes. - This value suggests a risk for developing diabetes but does not meet the diagnostic criteria for diabetes itself. *≥180 mg/dl* - While a fasting glucose level of **180 mg/dL or higher** is clearly indicative of diabetes, it is not the lowest value that defines overt diabetes. - The diagnostic threshold for diabetes is established at **126 mg/dL**, making this value simply an even higher indication of the condition.
Question 10: Consider the following statements regarding HCG : 1. HCG is a glycoprotein with two subunits α and β. 2. HCG levels reach the maximum between the 60th and 70th day in a normal pregnancy. 3. HCG is secreted by the syncytiotrophoblast. Which of the statements given above is/are correct ?
- A. 2 and 3 only
- B. 1 and 2 only
- C. 1 and 3 only
- D. 1, 2 and 3 (Correct Answer)
Explanation: ***Correct: 1, 2 and 3*** - **Human Chorionic Gonadotropin (HCG)** is a **glycoprotein hormone** composed of **alpha (α) and beta (β) subunits**, making statement 1 correct - HCG is primarily secreted by the **syncytiotrophoblast** cells of the placenta, confirming statement 3 - In a normal pregnancy, HCG levels typically **peak between 60-70 days (8-10 weeks)** after the last menstrual period, supporting statement 2 - All three statements are factually accurate regarding HCG structure, secretion, and physiological levels *Incorrect: 2 and 3 only* - This option incorrectly excludes statement 1 about HCG being a glycoprotein with α and β subunits - The structural composition of HCG as a heterodimeric glycoprotein is a fundamental characteristic *Incorrect: 1 and 2 only* - This option incorrectly excludes statement 3 about syncytiotrophoblast being the source of HCG - The syncytiotrophoblast is the outer layer of the trophoblast responsible for HCG secretion *Incorrect: 1 and 3 only* - This option incorrectly excludes statement 2 about HCG peak timing during pregnancy - Understanding that HCG peaks at 8-10 weeks (60-70 days) is crucial for monitoring early pregnancy
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