Interactive diabetes case 11: A 34-year-old pregnant patient with type 2 diabetes – A1

ANSWER — Correct.

Intensive therapy of diabetes in pregnancy reduces the risks of spontaneous abortion, fetal macrosomia (and its complications, including birth trauma to mother and child), neonatal hypoglycemia, and other neonatal complications (including hypocalcemia, hyperbilirubinemia, polycythemia, and respiratory distress).

Intensive insulin therapy, if initiated before pregnancy or very early in gestation, will also reduce the risk of congenital malformations. However, in this patient, intensive therapy will not reduce the risk of congenital malformations. Fetal organogenesis is nearly complete at seven weeks of gestation. Counseling and planning before pregnancy are essential in women of childbearing age who have diabetes so that conception occurs when the patient has achieved glycemic goals. Unfortunately, this is the exception rather than the rule in women with diabetes.

This patient had access to medical care but did not take advantage of it until she was already pregnant. Women of childbearing age with diabetes often have inadequate access to medical care, especially women in certain ethnic groups with a high prevalence of type 2 diabetes.

You refer the patient to an obstetrician with expertise in high-risk pregnancies. You advise her to return immediately to a retinal specialist for a dilated eye examination and for frequent monitoring during pregnancy.

What do you recommend with respect to monitoring of blood glucose levels?

●You advise the patient to check fingerstick blood glucose values before meals and at bedtime. (See "Interactive diabetes case 11: A 34-year-old pregnant patient with type 2 diabetes – B1".)

●You advise the patient to check fingerstick blood glucose values before meals, one hour after the beginning of each meal, and at 2 or 3 AM. (See "Interactive diabetes case 11: A 34-year-old pregnant patient with type 2 diabetes – B2".)