Management of Postpartum Care for Women with History of Gestational Diabetes and Hypertension

Patient Assessment and Monitoring

A 41-year-old female with a history of gestational diabetes and hypertension should undergo repeat testing of A1C, renal function, liver function, and cholesterol in October, as recommended by the American Diabetes Association 1
Women with a history of gestational diabetes should be tested for persistent diabetes or prediabetes at 4-12 weeks postpartum with a 75-g OGTT, according to the American Diabetes Association 3
The patient's elevated random blood glucose of 11.5 mmol/L indicates possible persistent dysglycemia after gestational diabetes, and A1C testing is appropriate to assess for diabetes or prediabetes, as suggested by the American Diabetes Association 1, 3

The American Diabetes Association recommends an A1C target for non-pregnant adults to be individualized based on risk factors, with a general target of <7%, as stated by the American Diabetes Association 4
If A1C confirms diabetes (≥6.5%) or prediabetes (5.7-6.4%), implement appropriate management, including medical nutrition therapy with a registered dietitian and regular physical activity, as recommended by the American Diabetes Association 1, 5
Consider metformin for prediabetes, especially with risk factors, as suggested by the American Diabetes Association 4

Assess overall cardiovascular risk and consider statin therapy based on risk profile, as recommended by the American Heart Association 4
Low-dose aspirin may be indicated if elevated cardiovascular risk, according to the American Heart Association 4
Continue Olmesartan with a target blood pressure <130/80 mmHg for patients with diabetes or high cardiovascular risk, as recommended by the American Heart Association 4

Schedule follow-up after October laboratory tests to adjust the management plan, as recommended by the American Diabetes Association 1
If prediabetes is confirmed, implement diabetes prevention strategies, including lifestyle modifications and consideration of metformin, as suggested by the American Diabetes Association 4
Provide contraceptive counseling if planning future pregnancy, as recommended by the American College of Obstetricians and Gynecologists 5