Image Quizzes

Fatigue and blurred vision

Reviewed by Courtney Whittle, MD, MSW, Diplomate of ABOM

IR_Stone / Thinkstock

A 32-year-old Asian American woman (gravida 2 para 1) presents at 26 weeks' gestation for experiencing fatigue and blurred vision. The patient's previous pregnancy 3 years earlier was an uncomplicated vaginal delivery at 38 weeks' gestation. The baby weighed 7 lb 8 oz at delivery. The patient's maternal family history is notable for hypertension and type 2 diabetes (T2D). At the time of presentation, the patient is 5 ft 4 in, and her prepregnancy body mass index (BMI) was 31.8. Physical examination reveals blood pressure of 130/88 beats/min and fetal heart tones at 148 beats/min. She does not report ocular pain and there is no evidence of ocular redness, swelling, or discharge. The patient reports viral gastroenteritis approximately 10 days earlier, which has since resolved. A 1-hour oral glucose tolerance test (OGTT) at 24 weeks was abnormal; a subsequent 3-hour OGTT showed:

• 109 mg/dL (7:30 AM)
• 205 mg/dL (8:30 AM)
• 164 mg/dL (9:30 AM)
• 166 mg/dL (10:30 AM)

What is the diagnosis?

Adult optic neuritis


Gestational diabetes

Fungal endophthalmitis

Gestational diabetes is a significant health problem worldwide that is associated with immediate and lifelong consequences for the affected woman and her infant. Gestational diabetes increases the risk for pregnancy-related complications, such as induced labor, cesarean delivery, and preeclampsia. There is also an increased risk for neonatal complications, including large-for-gestational-age birth weight, shoulder dystocia, birth injuries, lung disease, jaundice, and hypoglycemia. Regardless of birth weight, neonates born to mothers with gestational diabetes have greater adiposity than do neonates born to mothers without obesity and with normal glucose tolerance, and they have a predilection toward obesity and obesity-related metabolic disorders, including T2D in childhood and adulthood. Similarly, women who develop gestational diabetes have an increased lifetime risk for T2D as well as an increased risk for cardiovascular disease even if they do not progress to T2D.

According to the International Diabetes Federation, 1 in 6 pregnancies is affected by gestational diabetes. Risk factors include higher age and BMI, previous history of gestational diabetes, a family history of T2D, and polycystic ovarian syndrome. Patients may have few, if any, symptoms of gestational diabetes, or they may mistake their symptoms for the normal side effects of pregnancy. Potential symptoms include blurred vision, tingling or numbness in the hands and/or feet, excessive thirst, frequent urination, sores that heal slowly, and excessive fatigue.

The American Diabetes Association (ADA) states that the treatment of gestational diabetes should include medical nutrition therapy, physical activity, and weight management, depending on pregestational weight. Glucose monitoring is essential: Patients should aim for fasting glucose < 95 mg/dL (5.3 mmol/L) and either 1-hour postprandial glucose < 140 mg/dL (7.8 mmol/L) or 2-hour postprandial glucose < 120 mg/dL (6.7 mmol/L). According to the ADA, insulin should be added to lifestyle modifications if needed to achieve glycemic targets. Metformin and glyburide are not recommended as first-line agents because both cross the placenta to the fetus. Long-term safety data are not available for the use of other oral and noninsulin injectable glucose-lowering medications during pregnancy.

Courtney Whittle, MD, MSW, Diplomate of ABOM, Pediatric Lead, Obesity Champion, TSPMG, Weight A Minute Clinic, Atlanta, Georgia.

Courtney Whittle, MD, MSW, Diplomate of ABOM, has disclosed no relevant financial relationships.

Image Quizzes are fictional or fictionalized clinical scenarios intended to provide evidence-based educational takeaways.

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