QUESTION 19

 A 32-year-old woman, gravida 2 para 1, comes to the office at 32 weeks gestation to discuss her gestational diabetes test results. At

28 weeks gestation, the patient had a 1-hour 50-g glucose challenge test with an elevated result of 146 mg/dl At 30 weeks

gestation, she subsequently underwent a 100-g 3-hour glucose tolerance test Results of the 3-hour glucose tolerance test are as

follows:

Fasting

1-hour postprandial

2-hour postprandial

3-hour postprandial

74 mg/dl

230 mg/dl

210 mg/dl

180 mg/dl

The patient has otherwise had an uncomplicated pregnancy and walks 3 or 4 times a week for 30-60 minutes. Pre-pregnancy BMI

was 18 kg/m2; she has gained 8.6 kg (19 lb) during this pregnancy. The patient eats a predominately plant-based diet with fish and

meat once or twice a week. Her first pregnancy ended in a vaginal delivery of a healthy term infant of average weight for gestational

age. The patient's maternal grandfather had type 2 diabetes mellitus and died of a stroke at age 76. Her mother had primary

hypothyroidism and died at age 60 in a car accident. Her father died of pancreatic cancer at age 60. An ultrasound at this visit shows

an estimated fetal weight at the 50th percentile. Which of the following is the most likely mechanism for the patient's laboratory

results?

Q A Autoimmune destruction of pancreatic islet cells

Q B. Decreased somatomammotropin production

 C. Excess intake of simple carbohydrates

0 D. Inadequate exercise

O E. Increased insulin resistance

O F. Normal glucose homeostasis in pregnancy