Maternity nurse, must be aware that screening for Diabetes mellitus in pregnancy is done at

JIPMER Nursing Officer-2017

Obstetrics & Gynaecology

Easy

Appeared in: JIPMER Nursing Officer-2017

Explanation

The standard, universally recommended window for Gestational Diabetes Mellitus (GDM) screening in pregnant women without pre-existing diabetes is between 24 and 28 weeks of gestation.
This timing is optimal because insulin resistance, driven by placental hormones (like human placental lactogen), peaks during this period.
Screening within this window allows for timely diagnosis and management, which is crucial for preventing maternal and fetal complications such as macrosomia, preeclampsia, and neonatal hypoglycemia.

Option A: This period is generally too early for routine GDM screening because pregnancy-induced insulin resistance has not yet become significant.
Option B: Screening between 18 and 23 weeks is not standard practice because insulin resistance is still rising and has not reached its peak, potentially leading to false-negative results.
Option D: Screening this late in pregnancy is not recommended as it delays diagnosis and limits the time for effective intervention before delivery.

Clinical Relevance

Nursing practice connection: Knowing Standard screening timeline for Gestational Diabetes Mellitus (GDM) during pregnancy helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Timely GDM screening is a critical nursing responsibility in antenatal care to mitigate risks of preeclampsia, macrosomia, shoulder dystocia, and neonatal hypoglycemia.
Nurses play a key role in educating patients about the screening process (e.g., the Glucose Challenge Test and Glucose Tolerance Test), dietary modifications, and blood glucose self-monitoring.
Postpartum counseling is essential. Nurses must inform patients with GDM about their 7- to 10-fold increased lifetime risk of developing type 2 diabetes and the importance of follow-up testing and lifestyle changes.

How to Approach the Question

First, identify the core of the question: it asks for the standard timing of diabetes screening in pregnancy.
Recognize that this refers to Gestational Diabetes Mellitus (GDM), a condition that develops during pregnancy.
Recall the pathophysiology of GDM: it's caused by placental hormones that create insulin resistance, which peaks in the late second to early third trimester.
Evaluate the options based on this physiological peak. Eliminate options that are too early (before peak insulin resistance) or too late (not enough time for management before birth).
Select the timeframe that aligns with established clinical guidelines for GDM screening, which is 24-28 weeks.

Concept Tested & Keywords

Concept Tested: Standard screening timeline for Gestational Diabetes Mellitus (GDM) during pregnancy.
Stem keywords: Screening, Diabetes mellitus, pregnancy
Lead-in keywords: done at

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E6 Medicine Davidson Principles Practice 24e p. 1298-1300

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