The following is/are true regarding non-communicable diseases:

• a)
  

  They are one of the most important causes of the death in developed, middle and low-income countries.

  
  
• b)
  

  90% of mortality due to NCDs are in patients lower than 60 years in middle and low-income countries

  
  
• c)
  

  90% of mortality due to NCDs are in patients lower than 60 years in developed countries

  
  
• d)
  

  There is insufficient information to know the real impact of NCDs on population health in developed countries

  
  
• e)
  

  NCDs are especially important in women who have had complications in previous pregnancies.

Which of the following is/are considered important influences on the fetal genomic process during pregnancy and are likely to be responsible for some of the NCDs in adult life.

• a)
  

  Over nutrition

  
  
• b)
  

  Under nutrition

  
  
• c)
  

  Diabetes

  
  
• d)
  

  Anaemia

  
  
• e)
  

  Hypertension

To combat this process of developmental origins of health which of the following need to be addressed?

• a)
  

  Health systems

  
  
• b)
  

  Education of the population

  
  
• c)
  

  Economics of the country

  
  
• d)
  

  Improving social conditions

  
  
• e)
  

  Malnutrition

In which sense can FIGO help to reduce the impact of NCDs in the future?

• a)
  

  FIGO will not be able to influence this process, as it is not a society with sufficient scientific knowledge or expertise.

  
  
• b)
  

  FIGO can include prevention strategies (including educational tools and training activities to professionals, etc.) during prenatal care to avoid the adverse influence of some factors.

  
  
• c)
  

  FIGO’s statements and recommendations are generally well accepted by the majority of countries with good health services.

  
  
• d)
  

  FIGO should only help to maintain National registers to capture data that can help to identify cause and effect i.e. Pregnancy history and outcomes linked to NCDs.

  
  
• e)
  

  FIGO must emphasise that the health of the pregnant woman is a Human right and no further action is needed.

What may be the characteristics of a neonate born to a mother with diabesity?

• a)
  

  Increased proportion of lean body mass

  
  
• b)
  

  More body fat

  
  
• c)
  

  Elevated cord blood insulin

  
  
• d)
  

  Enhanced erythropoesis

  
  
• e)
  

  Relative hypoxia

How does the placenta contribute to fetal diabesity characteristics?

• a)
  

  It limits transport of maternal glucose to the fetus late in gestation

  
  
• b)
  

  It increases placental vascularization

  
  
• c)
  

  It produces more insulin

  
  
• d)
  

  It does not contribute at all

  
  
• e)
  

  It changes its structure

The early period in a pregnancy is important, because of which of the following?

• a)
  

  The maternal environment has an effect on early placental development

  
  
• b)
  

  The fetal pancreas already produces and releases insulin

  
  
• c)
  

  In the amniotic fluid insulin has been measured before 15 weeks of gestation

  
  
• d)
  

  Placental volume at this stage associates with fetal anthropometric parameters in the third trimester

  
  
• e)
  

  Because of the demonstrated effect of fetal insulin at this stage in pregnancy on the risk of childhood obesity

The risk of non-communicable diseases globally can be best addressed by which of the following?

• a)
  

  Drug discovery to treat those at risk

  
  
• b)
  

  Genetic screening

  
  
• c)
  

  A lifecourse approach, focusing on different opportunities in different contexts

  
  
• d)
  

  More widespread use of treatments in affected older adults

  
  
• e)
  

  Meeting the challenge of climate change

Iron supplementation and raised serum ferritin levels in non-anaemic pregnant women may increase the risk of which of the following?

• a)
  

  Still births

  
  
• b)
  

  Gestational diabetes mellitus

  
  
• c)
  

  Polycythemia in the offspring

  
  
• d)
  

  Placental abruption

  
  
• e)
  

  Pre-eclampsia

The following is/are true regarding anaemia in pregnancy?

• a)
  

  Two thirds of affected women are from Asia

  
  
• b)
  

  Nutritional folate deficiency anaemia is the commonest cause of anaemia

  
  
• c)
  

  It is associated with increased maternal and perinatal morbidity and mortality

  
  
• d)
  

  It carries a significantly higher risk of both LBW and preterm birth

  
  
• e)
  

  Iron supplementation during pregnancy significantly lowers the incidence of both LBW and preterm birth.

Severe anaemia during pregnancy is associated with increased risk of

• a)
  

  Gestational hypertension

  
  
• b)
  

  Pre-eclampsia

  
  
• c)
  

  Pre term delivery

  
  
• d)
  

  Low birth weight

  
  
• e)
  

  Stillbirth

Which of the following statement(s) is/are correct with regard to continuous Folic Acid supplementation throughout pregnancy?

• a)
  

  It lowers the risk of preterm births

  
  
• b)
  

  It increases the risk of GDM and insulin resistance, and future type 2 diabetes in the mother and offspring when associated with Vitamin B12 deficiency

  
  
• c)
  

  It eliminates the risk of neural tube defects

  
  
• d)
  

  It lowers the risk of neonatal jaundice

  
  
• e)
  

  It lowers the risk of stillbirth

The following is /are true regarding Vitamin D in pregnancy?

• a)
  

  Worldwide studies have shown high rates of Vitamin D deficiency among women of reproductive age

  
  
• b)
  

  There is an established link between low Vitamin D levels and pre-eclampsia

  
  
• c)
  

  There is an established link between low Vitamin D levels and GDM

  
  
• d)
  

  There is an established link between low Vitamin D levels and SGA

  
  
• e)
  

  There is an established link between low Vitamin D levels and LBW

Which of the following statements is/are correct about obesity/overweight in pregnancy?

• a)
  

  It eliminates the risk of low birth weight infants

  
  
• b)
  

  It is associated with lower risk of post-partum haemorrhage

  
  
• c)
  

  It is the most important modifiable risk for still births in high income countries

  
  
• d)
  

  It is a larger global problem than underweight

  
  
• e)
  

  It is associated with a higher risk of maternal infection

Which of the following statements is/are also correct about obesity/overweight in pregnancy?

• a)
  

  It is associated with gestational hypertension

  
  
• b)
  

  It is associated with pre-eclampsia

  
  
• c)
  

  It is associated with shoulder distocia

  
  
• d)
  

  It is associated with increased operative vaginal delivery

  
  
• e)
  

  It is associated with increased Caesarean section

Which of the following statements is/are correct with regard to GDM?

• a)
  

  Women at risk of GDM can be easily identified with careful history taking and physical examination

  
  
• b)
  

  It increases the risk of all conditions that are associated with maternal mortality and poor pregnancy outcomes.

  
  
• c)
  

  In overweight and obese pregnancy patients, insulin resistance and hyperglycemia is a result of placental hormones activity

  
  
• d)
  

  In overweight and obese pregnancy patients, insulin resistance and hyperglycemia is a result of Increased release of adipokines and leptin

  
  
• e)
  

  In overweight and obese pregnancy patients, insulin resistance and hyperglycemia is a result of GLUT4 translocation

Which of the following statements is/are correct regarding hypertensive disorders?

• a)
  

  Hypertensive pregnancy disorders (HPDs) account for less than 5% of maternal deaths in the developing world

  
  
• b)
  

  Worldwide, approximately 10% of normotensive women experience elevated blood pressure at some point during pregnancy

  
  
• c)
  

  There is a well extablished international consensus about the definition of HPDs

  
  
• d)
  

  Chronic pre-eclampsia is a well recognised condition in the classification of HPDS

  
  
• e)
  

  Of the classified HPDS gestational hypertension has the highest impact on mortality and morbidity

Which of the following is/are recognised as direct complications of pre-eclampsia?

• a)
  

  Acute renal faliure

  
  
• b)
  

  Cerebro-vascular accident

  
  
• c)
  

  Impaired glucose tolerance

  
  
• d)
  

  Thrombocytopaenia

  
  
• e)
  

  Pulmonary oedema

In which of the following conditions would pre-conceptual care be considered vital?

• a)
  

  Type 1 diabetes

  
  
• b)
  

  Epilepsy

  
  
• c)
  

  Pre-existing renal failure

  
  
• d)
  

  SLE

  
  
• e)
  

  Cyanotic heart disease

Which of the following health professionals should contribute towards pre-conceptual care?

• a)
  

  Obstetricians

  
  
• b)
  

  Pediatricians

  
  
• c)
  

  Family physicians

  
  
• d)
  

  Medical specialists

  
  
• e)
  

  Midwives

Which of the following diabetic related complications can be reduced by pre-conceptual care?

• a)
  

  Congenital malformations

  
  
• b)
  

  Miscarriage

  
  
• c)
  

  Perinatal death

  
  
• d)
  

  Macrosomia

  
  
• e)
  

  Preterm delivery

The following statement(s) is/are true about pre-pregnancy counselling for the obese patient?

• a)
  

  By the time of pregnancy diagnosis in the obese patient, the impaired organogenesis may have already occurred

  
  
• b)
  

  Weight tends to decrease with subsequent pregnancies.

  
  
• c)
  

  Decrease in pre-gravid weight between the first and second pregnancies from obese to a normal BMI decreases the risk of Caesarean delivery

  
  
• d)
  

  Decrease in pre-gravid weight between the first and second pregnancies from obese to a normal BMI decreases the risk of pre-eclampsia

  
  
• e)
  

  Inter-pregnancy weight reduction among women with obesity has been shown to significantly reduce the risk of developing GDM

Which of the following complications is/are associated with maternal obesity?

• a)
  

  Spontaneous miscarriage

  
  
• b)
  

  Recurrent miscarriage

  
  
• c)
  

  Infertility

  
  
• d)
  

  Congenital anomalies

  
  
• e)
  

  Chromosomal anomalies

Which of the following statements is/are true regarding labour and delivery in the obese gravid patient?

• a)
  

  Obese women are less likely than normal-weight women to have an induction of labour

  
  
• b)
  

  Obese women are more likely to have an inadequate contraction pattern during the first stage of labour, and subsequently have a longer first stage

  
  
• c)
  

  There is an increased risk of macrosomia

  
  
• d)
  

  There is a decreased risk of operative vaginal delivery

  
  
• e)
  

  There is an increased risk of shoulder dystocia

Regarding GDM, which of the following sentences is/are true?

• a)
  

  The prevalence of GDM varies in direct proportion to the prevalence of type 2 DM.

  
  
• b)
  

  The relationship between type 2 diabetes mellitus (DM) and GDM depends on the ethnic population being studied.

  
  
• c)
  

  Malnutrition is thought to explain the relatively high prevalence of diabetes in low resource countries

  
  
• d)
  

  Overnutrition is thought to explain the relatively high prevalence of diabetes in low resource countries

  
  
• e)
  

  Socio-economic aspects are thought to explain the relatively high prevalence of diabetes in low resource countries

The Diabetes Prevention Program (DPP), a multi-centre randomized trial of an intensive lifestyle intervention conducted among a population of adults who had elevated fasting and post-load plasma glucose concentrations, faced which of the following important limitation(s)?

• a)
  

  The study involved an intensive intervention not easily administered in a clinical setting.

  
  
• b)
  

  The lifestyle intervention focused on weight loss in the absence of guidelines for physical activity.

  
  
• c)
  

  Inadequate follow-up time occurred between the diagnosis of GDM and the subsequent development of diabetes.

  
  
• d)
  

  Important diabetes risk factors such as diet were not addressed in the analysis.

  
  
• e)
  

  The number of participants was too small to demonstrate an effect

The following statement(s) is/are true about the majority of randomized controlled trials of lifestyle intervention studies designed to reduce the risk of subsequent diabetes among women diagnosed with GDM:

• a)
  

  The majority incorporated breastfeeding as a primary outcome.

  
  
• b)
  

  The majority were large, multi-centre clinical trials.

  
  
• c)
  

  The majority were conducted among diverse racial and ethnic groups.

  
  
• d)
  

  The majority were conducted with cultuarally-modified interventions

  
  
• e)
  

  The majority were pilot or feasibility studies.

Behaviour change interventions in the postpartum period should address which of the following?

• a)
  

  The relatively low perceived risk of future diabetes among women with recent GDM.

  
  
• b)
  

  Suboptimal levels of physical activity and fruit and vegetable intake in the postpartum period.

  
  
• c)
  

  The need to involve family members.

  
  
• d)
  

  The interest of the majority of women with prior GDM in attending group sessions.

  
  
• e)
  

  Home-based interventions as these are more feasible for women

Overweight, obese women who engage in 150 min or more a week of physical activities prior to pregnancy experience which of the following?

• a)
  

  Reduced fertility

  
  
• b)
  

  Lower risk of developing gestational diabetes

  
  
• c)
  

  More frequent clinic visits

  
  
• d)
  

  Significant weight loss

  
  
• e)
  

  The requirement for medical clearance prior to exercise

A 30 year gravida 3, para 2 is first seen in the clinic at 8 weeks gestation, she had no prior obstetric or medical complications. Her BMI is 31. From her experience with prior pregnancies her understanding is that during pregnancy she should rest as much as possible and that pregnancy is not an appropriate time to diet. Which of the following is/are true with respect to this?

• a)
  

  Pregnancy is not a time for behaviour modification

  
  
• b)
  

  Exercise in pregnancy is detrimental to the developing fetus

  
  
• c)
  

  Diet in pregnancy is detrimental to the developing fetus

  
  
• d)
  

  Pregnancy is an ideal time for behaviour modification

  
  
• e)
  

  Physical activity early and through pregnancy lowers the risk of gestational diabetes