Approach to diabetes in pregnancy Quiz: Ace Your Exams

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A 28-year-old woman, gravida 2 para 1, at 10 weeks gestation presents to the office for an initial prenatal visit. She feels well and has no concerns. She has a history of polycystic ovarian syndrome (PCOS). The patient’s first pregnancy was uncomplicated, and her child was born weighing 4.2 kg. She takes a prenatal vitamin. She does not use tobacco, alcohol, or recreational drugs. Temperature is 36.7 ºC (98.1 ºF), pulse is 90/min, respiratory rate is 16/min, and blood pressure is 130/80 mm Hg. BMI is 31 kg/m2. Fetal heart rate is 175/min on Doppler ultrasound. Physical examination shows no abnormalities. Which of the following is the most appropriate diabetes mellitus screening strategy for this patient?

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Screen at 24 to 28 weeks of gestation

Initiate metformin and screen at 24 to 28 weeks of gestation

Screen now; if negative, no need for follow-up screening at 24-28 weeks of gestation

Daily self-monitoring of glucose levels

Screen now; if negative, rescreen at 24 to 28 weeks of gestation