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Gestational diabetes — DRCOG MCQ

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HardAntenatal CareGestational diabetesDRCOG

A 32-year-old with BMI 34 kg/m² and family history of diabetes has a 75 g OGTT at 26 weeks: fasting glucose 5.7 mmol/L and two-hour glucose 7.3 mmol/L. How should this be interpreted?

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Correct answer: D — Gestational diabetes based on the fasting value

The best answer is “Gestational diabetes based on the fasting value”. NICE diagnoses gestational diabetes when either fasting glucose is at least 5.6 mmol/L or the two-hour value is at least 7.8 mmol/L. Her fasting value therefore establishes the diagnosis despite the lower two-hour value. She should be reviewed by the joint diabetes and antenatal team within one week. The UK pathway uses a 75 g two-hour OGTT, not the US 50 g screen followed by a 100 g three-hour test. Women with risk factors are tested at 24–28 weeks, while previous gestational diabetes prompts early self-monitoring or an early OGTT with repeat testing if normal. Diagnostic thresholds are fasting glucose at least 5.6 mmol/L or two-hour glucose at least 7.8 mmol/L.

Reference: NICE NG3: Diabetes in pregnancy: https://www.nice.org.uk/guidance/ng3/chapter/recommendations