Interactive diabetes case 11: A 34-year-old pregnant patient with type 2 diabetes – A3

ANSWER — Incorrect.

The patient and her husband want this pregnancy. The patient had already improved her diet in anticipation of pregnancy, with a fall in the glycated hemoglobin (A1C) level, albeit to a level that is still elevated. The risk of major congenital malformations in infants of mothers who have extremely high A1C levels at the time of pregnancy is elevated three- to fourfold compared with infants of mothers without diabetes, and therapeutic termination of pregnancy could be discussed in this setting. However, in this patient, the A1C level of 8.6 percent during the early part of pregnancy poses only a modestly increased risk of congenital malformations, and urgent referral for a therapeutic abortion, although always an option for the mother, appears to be out of proportion to the risk.

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 such those with Hispanic ethnicity.

Return to the beginning to try again. (See "Interactive diabetes case 11: A 34-year-old pregnant patient with type 2 diabetes".)