A 32-year-old G1P0 woman at 27 weeks estimated gestational age presents for her first prenatal care appointment. She recently immigrated to the United States and didn’t receive any prenatal care in her country. Her blood pressure is 130/70 mm Hg, pulse is 85/min, and respirations are 16/min. Her BMI is 38.3 kg/m2. Physical examination is unremarkable except for normal pregnancy changes. Fetal ultrasound is performed and reveals fetal macrosomia. Which one of the following diagnostic tests is most likely to reveal the cause of this fetal abnormality?
ALeptin
BC-peptide
COral glucose tolerance test
DGlycated hemoglobin
ESerum insulin
A 31-year-old G1P0000 presents to her obstetrician for her first prenatal visit after having a positive home pregnancy test one week ago. She states that her last menstrual period was 8 weeks ago. The patient has a past medical history of type I diabetes mellitus since childhood and is on insulin. Her hemoglobin A1c two weeks ago was 13.7%. At that time, she was also found to have microalbuminuria on routine urinalysis, and her primary care provider prescribed lisinopril but the patient has not yet started taking it. The patient’s brother is autistic, but family history is otherwise unremarkable. At this visit, her temperature is 98.6°F (37.0°C), blood pressure is 124/81 mmHg, pulse is 75/min, and respirations are 14/min. Exam is unremarkable. This fetus is at increased risk for which of the following?
APost-term delivery
BOligohydramnios
CNeural tube defect
DAneuploidy
ENeonatal hyperglycemia
A 31-year-old G1P0 woman at 26 weeks gestation presents to the clinic for evaluation of an abnormal glucose tolerance test. She denies any symptoms, but states that she was given 50 g of oral glucose 1 week earlier and demonstrated a subsequent venous plasma glucose level of 156 mg/dL 1 hour later. The vital signs are: blood pressure, 112/78 mm Hg; pulse, 81/min; and respiratory rate, 16/min. Physical examination is within normal limits. Which of the following is the most appropriate next step in management?
AAdminister an oral, 3-hour 100 g glucose dose
BAdvise the patient to follow an American Diabetic Association diet plan
CRepeat the 50 g oral glucose challenge
DBegin insulin treatment
EOrder a fetal ultrasound examination
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