If gestational diabetes screening is positive, what is the next step?

• A. Immediate insulin therapy
• B. No further testing
• C. Cesarean delivery
• D. Diagnostic testing to confirm diabetes (e.g., oral glucose tolerance test)

Answer: (D)

When screening for gestational diabetes comes back positive, you don’t start treatment yet—you need to confirm the diagnosis with a diagnostic test. The screening is designed to flag those at risk, but it isn’t definitive by itself. The standard diagnostic test is an oral glucose tolerance test. It directly measures how the body handles a glucose load, checking glucose levels at fasting and after glucose intake to determine whether true hyperglycemia consistent with gestational diabetes is present. Only if the OGTT meets the established diagnostic criteria is gestational diabetes diagnosed. From there, management decisions—diet and exercise, blood glucose monitoring, and potential medications—are based on that confirmed diagnosis. Immediate insulin therapy or cesarean delivery aren’t next steps solely based on a positive screen, and no further testing isn’t appropriate because confirmation is required.