In a woman s/p cesarean with a history of gestational diabetes, what is the recommended DM screening postpartum?

• A. No change from regular recommendations
• B. A1c at 6 weeks postpartum and then annually
• C. A1c every 6 months for first 2 years after delivery, then return to normal screening guidelines
• D. A1c annually

Answer: (C)

Women with a history of gestational diabetes continue to be at high risk for developing type 2 diabetes after delivery, especially in the first couple of years. The most effective way to catch this early is to monitor glycemic status more frequently during that high-risk period. Using A1c every six months for the first two years after delivery provides timely detection of progression to diabetes or prediabetes and allows early lifestyle or treatment interventions. After this two-year window, if results remain normal, screening can return to the usual rhythm based on general risk factors. A1c reflects average glucose over about three months and offers a convenient, non-fasting measure for ongoing surveillance. If the A1c indicates diabetes or prediabetes, appropriate steps are taken and testing is repeated to confirm persistence.