A 32-year-old woman with pre-gestational Type 1 diabetes mellitus is at 8 weeks gestation. Her HbA1c is 9.2%. What is the MOST important concern at this gestational age?
- A Macrosomia due to maternal hyperglycemia
- B Congenital anomalies (cardiac and neural tube defects) due to poor periconceptional glycemic control ✓
- C Gestational hypertension risk in the second trimester
- D Neonatal hypoglycemia due to fetal hyperinsulinism
Correct answer: B. Congenital anomalies (cardiac and neural tube defects) due to poor periconceptional glycemic control
Explanation
Poor periconceptional and first-trimester glycemic control (evidenced by high HbA1c of 9.2% at 8 weeks) is strongly associated with congenital malformations. The most common anomalies in diabetic embryopathy include cardiac defects (VSD, TGA), neural tube defects (sacral agenesis/caudal regression syndrome), and other structural abnormalities — these are related to hyperglycemia during the organogenesis period (3–8 weeks). Macrosomia and neonatal hypoglycemia are complications of poor glucose control in the second/third trimester and peripartum, respectively.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.