Week 14 - pregnancy complications pt 2 /
clinical case Test Exam (2026-2027
Updated Version) with Comprehensive
Questions and Detailed Solutions /
Already Graded A+
When is gestational diabetes (GDM) usually diagnosed?
In second or third triemster (24-28 weeks)
GDM results from increased _____ ____ caused by placenta
hormones AND inadequate ______ ____-_____ compensation,
leading to maternal hyperglycemia and fetal glucose exposure
Insulin resistance; pancreatic beta-cells
How do placental hormones contribute to insulin resistance in
GDM?
Hormones (hPL, progesterone, cortisol and placental GH) impair
insulin signaling and reduce peripheral glucose uptake
In GDM, the pancreas fails to increase insulin secretion sufficiently
to overcome to resistance, leading to persistent ______
Hyperglycemia
In GBM, Maternal glucose crosses placenta and the fetus becomes
hyperglycemic. The fetal pancreas responds with _____. High
insulin acts as a growth factor hormone causing ______. After
birth, the loss of maternal glucose occurs, but there is persistent
insulin, leading to ____ _____
Hyperinsulinemia; macrosomia; neonatal hypoglycemia
How does normal pregnancy metabolism differ from GDM?
, Normal pregnancy becomes insulin resistant late, but GDM occurs
when the body cannot compensate for this pathologic resistance
What is the strongest risk factor for GDM?
Prior history of GBM
What are other key modifiable risk factors for GDM?
-Obesity (BMI > 30)
-Physical inactivity
-Prediabetes
-Excess gestational weight gain
When is the universal screening for GDM performed and why?
-24-28 weeks
-Insulin resistance increases during the 2nd trimester due to rising
placental hormones
When is early screening for GDM done for those of high risk?
At the first prenatal visit for undiagnosed T2DM
What is the two step approach for screening for GDM?
-step 1: 50gm glucose challenge test (non-fasting), levels measured
after 1 hour
-If step 1 results are >130-140, it is positive and need to do step 2
-Step 2: 100gm OGTT (fasting)
What values diagnose GDM on the step 2 100gm OGTT?
> 2 abnormal values: fasting > 95, 1 hr > 180, 2hr >155, 3hr >140
How do you distinguish pre-existing diabetes from GDM early in
pregnancy?
Fasting >126 and A1c > 6.5% indicates pre-existing DM, not GDM
What are possible symptoms of GDM?
-usually asymptomatic ("silent nature")
-polyuria, polydipsia
-fatigue
-nausea
-blurred vision
-recurrent candidiasis
What are some clinical clues suggesting possible GDM?
Polyhydramnios, fetal macrosomia, or recurrent infections like
candidiasis
clinical case Test Exam (2026-2027
Updated Version) with Comprehensive
Questions and Detailed Solutions /
Already Graded A+
When is gestational diabetes (GDM) usually diagnosed?
In second or third triemster (24-28 weeks)
GDM results from increased _____ ____ caused by placenta
hormones AND inadequate ______ ____-_____ compensation,
leading to maternal hyperglycemia and fetal glucose exposure
Insulin resistance; pancreatic beta-cells
How do placental hormones contribute to insulin resistance in
GDM?
Hormones (hPL, progesterone, cortisol and placental GH) impair
insulin signaling and reduce peripheral glucose uptake
In GDM, the pancreas fails to increase insulin secretion sufficiently
to overcome to resistance, leading to persistent ______
Hyperglycemia
In GBM, Maternal glucose crosses placenta and the fetus becomes
hyperglycemic. The fetal pancreas responds with _____. High
insulin acts as a growth factor hormone causing ______. After
birth, the loss of maternal glucose occurs, but there is persistent
insulin, leading to ____ _____
Hyperinsulinemia; macrosomia; neonatal hypoglycemia
How does normal pregnancy metabolism differ from GDM?
, Normal pregnancy becomes insulin resistant late, but GDM occurs
when the body cannot compensate for this pathologic resistance
What is the strongest risk factor for GDM?
Prior history of GBM
What are other key modifiable risk factors for GDM?
-Obesity (BMI > 30)
-Physical inactivity
-Prediabetes
-Excess gestational weight gain
When is the universal screening for GDM performed and why?
-24-28 weeks
-Insulin resistance increases during the 2nd trimester due to rising
placental hormones
When is early screening for GDM done for those of high risk?
At the first prenatal visit for undiagnosed T2DM
What is the two step approach for screening for GDM?
-step 1: 50gm glucose challenge test (non-fasting), levels measured
after 1 hour
-If step 1 results are >130-140, it is positive and need to do step 2
-Step 2: 100gm OGTT (fasting)
What values diagnose GDM on the step 2 100gm OGTT?
> 2 abnormal values: fasting > 95, 1 hr > 180, 2hr >155, 3hr >140
How do you distinguish pre-existing diabetes from GDM early in
pregnancy?
Fasting >126 and A1c > 6.5% indicates pre-existing DM, not GDM
What are possible symptoms of GDM?
-usually asymptomatic ("silent nature")
-polyuria, polydipsia
-fatigue
-nausea
-blurred vision
-recurrent candidiasis
What are some clinical clues suggesting possible GDM?
Polyhydramnios, fetal macrosomia, or recurrent infections like
candidiasis
