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Gestational diabetes — USMLE Step 3 MCQ

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HardOB/GYN (prenatal care, contraception, screening)Gestational diabetesUSMLE Step 3

A woman treated with insulin for gestational diabetes delivers without complication. Insulin is stopped postpartum, and fasting capillary glucose before discharge is normal. Which test is recommended to detect persistent dysglycemia?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Schedule a 75-g 2-hour glucose-tolerance test at 4 to 12 weeks

The best answer is “Schedule a 75-g 2-hour glucose-tolerance test at 4 to 12 weeks”. A 75-g OGTT at 4 to 12 weeks is more sensitive than fasting glucose or A1c alone and is preferred because pregnancy-related red-cell turnover and delivery blood loss can distort A1c. Long-term screening continues every 1 to 3 years even when the postpartum test is normal.

Reference: ADA Standards of Care: Management of Diabetes in Pregnancy: https://diabetesjournals.org/care/article/49/Supplement_1/S328/163919/15-Management-of-Diabetes-in-Pregnancy