A 23-year-old gravida 2, para 1-0-0-1 woman with a history notable for gestational diabetes presents to establish prenatal care at 12 weeks’ gestation. Early diabetes screening was performed with a 50-g oral glucose challenge demonstrating an abnormal glucose screen. She subsequently underwent a diagnostic 100-g oral glucose tolerance test and was diagnosed with gestational diabetes in the first trimester.
She received counseling regarding dietary and exercise modifications and counseling on blood glucose monitoring. Assessment of an outpatient blood glucose log of fasting and postprandial values demonstrated persistent hyperglycemia and weight-based insulin was prescribed to optimize her glucose control. Long-acting insulin was administered twice daily and short-acting insulin was administered with each meal. Insulin dosing was titrated upward throughout her pregnancy to maintain euglycemia. The patient’s hemoglobin A1c was normal (5.4%) in the third trimester, demonstrating reassuring glycemic control.
Fetal assessment consisted of serial growth ultrasonography as well as weekly biophysical...
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