A 31-year-old woman who is at high risk for diabetes is at 18 weeks' gestation. During her first antenatal visit, which is the accurate approach to evaluating the patient for diabetes?
1. Begin serial testing of the patient's serum glucose and HA1c at 24 weeks' gestation.
2. If diabetes is diagnosed, consider this condition to be gestational diabetes mellitus (GDM).
3. Recognize HA1c equal to or greater than 4.5% or a fasting plasma glucose level equal to or greater than 90 mg/dl as being diagnostic of diabetes.
4. Conduct screening for type 2 diabetes mellitus as soon as possible.
Correct Answer: 4
Rationale 1: Women at high risk for type 2 DM should be screened for diabetes as soon as possible.
Rationale 2: Women who are determined to have diabetes at this visit should be diagnosed as having overt diabetes and not GDM.
Rationale 3: HA1c equal to or greater than 6.5% would be considered diagnostic as would a fasting plasma glucose level equal to or greater than 126 mg/dl or a 2-hour plasma glucose equal to or greater than 200 mg/dl during an oral glucose tolerance test (OGTT).
Rationale 4: Women at high risk for type 2 DM should be screened for diabetes as soon as possible.
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