Gestational diabetes mellitus

New (updated)

Step 1: View clinicals

A 29 year old primigravida of South Asian origin in her 24th week of pregnancy is referred for further management after her 50g 1 hour glucose challenge test result was found to be 146 mg/dL. The same test performed at 6 weeks gave a result of 124 mg/dL. Her medical history is unremarkable, but her family history is positive for type 2 diabetes in both parents.


Step 2: Order all relevant investigations

Urine dipstick for glucose

The dipstick test is positive for glucosuria.

100g 3hr OGTT

At 0 hours: 101 mg/dL (normal: <95) At 1 hour: 190 mg/dL (normal: <180) At 2 hours: 157 mg/dL (normal: <155) At 3 hours: 140 mg/dL (normal: <140)

HbA1c

Her HbA1c level is 6.3%

Urine protein test

Trace amounts of protein are noted.


Step 3: Select appropriate management

Insulin stat
ACE inhibitors
Monitor blood pressure
Deliver at 38 weeks


Score: ★★☆