30-year-old G3P2 patient visits an antenatal clinic at 20 weeks. She reveals during history that her first baby was 4.6 kg delivered by cesarean section, second baby was 4-8 kg delivered by c/section. Gynecologists suspect gestational diabetes and orders a GCT. The blood sugar levels after 50 gms of oral glucose are 206 mg/dl and the patient is thus confirmed as a case of gestational diabetes. All of the following are known complications of this condition except:
Susceptibility for infection
Fetal hyperglycemia
Congenital malformations in fetus
Neonatal hypoglycemia
Ans. is c, i.e. Congenital malformation in fetusRef. Textbook of Obs. Shiela Balakrishnan 1/e, p 288; Fernando Arias 3/e, p 445, 441In the question, patient is presenting to the antenatal clinic at 20 weeks and is diagnosed as a case of gestational diabetes.Note: Patients blood sugar levels after 50 gms of glucose i.e. after glucose challenge test are 206 mg/dl. Recall that if, after GCT blood sugar values are >=200mg/dl, there is no need for further testing by GTT and patient is diagnosed as a case of gestational diabetes.As discussed in the text - in gestational diabetes, blood sugar levels are raised beyond 20-24 weeks of pregnancy, due to insulin resistance and hence free radicals (responsible for causing congenital malformations) are formed after 20-24 weeks and therefore it does not lead to congenital malformation as organogenesis is already complete by this age. Rest all options are complications of diabetes.
Medical & Surgical Illness Complication Pregnancy