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Diabetes screening — USMLE Step 2 CK MCQ

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HardPreventive Medicine & BiostatisticsDiabetes screeningUSMLE Step 2 CK

A 34-year-old woman had insulin-treated gestational diabetes and delivered 8 weeks ago. Fasting glucose on postpartum day 2 was 96 mg/dL. She now feels well and asks whether further testing is necessary. Which test is most appropriate now?

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Correct answer: D — A fasting 75-g 2-hour oral glucose tolerance test

Gestational diabetes confers substantial risk of persistent dysglycemia and later type 2 diabetes. Formal postpartum testing should occur at 4-12 weeks, and a fasting 75-g 2-hour oral glucose tolerance test is the most sensitive way to identify fasting or post-challenge abnormalities. A normal value in the immediate postpartum physiologic transition does not replace this assessment. A random capillary value and the antenatal 50-g screening challenge are not diagnostic postpartum strategies. Hemoglobin A1c alone early postpartum can be misleading because pregnancy, delivery blood loss, and altered red-cell turnover affect it. If results are normal, ongoing diabetes screening is still required every 1-3 years.

Reference: ACOG Committee Opinion: Optimizing Postpartum Care: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care