Medical disorders: preconception care in diabetes: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Medical disorders: preconception care in diabetes

Sample item

A 30-year-old woman with type 2 diabetes and an HbA1c of 9.2 percent plans pregnancy. She is on metformin and glibenclamide. Which advice is most appropriate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Switch to insulin, aim for HbA1c below 6.5 percent before conception, and take folic acid 5 mg daily

Poor periconceptional control raises the risk of congenital malformations, including neural tube defects, cardiac anomalies and caudal regression, so HbA1c should be as close to normal as possible, ideally under 6.5 percent, before conception. Insulin is the standard drug during pregnancy, and high-dose folic acid (5 mg) is advised. Contraception should continue until control is achieved.

Option by option

  • A. Switch to insulin, aim for HbA1c below 6.5 percent before conception, and take folic acid 5 mg daily (correct)

    Correct. Optimise control with insulin first and give high-dose folic acid.

  • B. Continue glibenclamide, because it is safe throughout pregnancy

    Oral hypoglycaemics are generally replaced with insulin, so continuing glibenclamide is not the standard advice.

  • C. Take folic acid 0.4 mg since diabetes does not alter neural tube risk

    Diabetes raises neural tube risk, so the higher folic acid dose is recommended.

  • D. Conceive now and optimise control in the second trimester

    Organogenesis occurs in the first 8 weeks, so delay in control raises anomaly risk.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is A, Switch to insulin, aim for HbA1c below 6.5 percent before conception, and take folic acid 5 mg daily. Poor periconceptional control raises the risk of congenital malformations, including neural tube defects, cardiac anomalies and caudal regression, so HbA1c should be as close to normal as possible, ideally under 6.

Why is "Continue glibenclamide, because it is safe throughout pregnancy" not the answer?

Oral hypoglycaemics are generally replaced with insulin, so continuing glibenclamide is not the standard advice.

Why is "Take folic acid 0.4 mg since diabetes does not alter neural tube risk" not the answer?

Diabetes raises neural tube risk, so the higher folic acid dose is recommended.

Why is "Conceive now and optimise control in the second trimester" not the answer?

Organogenesis occurs in the first 8 weeks, so delay in control raises anomaly risk.

What concept does this question test?

It tests Medical disorders: preconception care in diabetes in OBG. 5 percent, before conception. Insulin is the standard drug during pregnancy, and high-dose folic acid (5 mg) is advised. Contraception should continue until control is achieved.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Medical disorders: preconception care in diabetes?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.