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Under Review

7/29/21, 4:11 PM

Dalton LaBarge

A 33yF G4P3104 presents for follow-up 4 weeks s/p C/S for LGA neonate and GDM. She feels like she has been slow to “get back to normal,” and reports having low energy. She has gained 5lbs since hospital discharge. She attempted breastfeeding but switched to formula because her milk production was inconsistent. Her surgical incision is healing adequately. Her postpartum depression screen is negative. Today’s outpatient labs show the following:

Serum Fasting Glucose: 120 mg/dl (nl <100)
2-hr Glucose Challenge: 189 mg/dl (nl <140)

What is the next best step in managing this patient’s condition?

Initiate metformin therapy for glycemic control

Reassess glycemic status at next annual health exam

CBT referral for postpartum depression counseling

Provide resources for home exercise routines

Correct Answer:

A

(a) Metformin is indicated as first line glycemic control for postpartum GDM patients with both Impaired Fasting Glucose and Insufficient Glandular Tissue (IGT) at their 4-12 week postpartum follow up.

(b)(c)(d) Annual glycemic control, weight loss and supportive services are all important in long term management but do not address her current IFG/IGT

“ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus.” Obstetrics and gynecology (New York. 1953) 131.2 (2018): e49–e64. Web.