Which of the following statements is/are true regarding GDM placental characteristics?

• a)

  The majority of placental changes in GDM are functional changes without obvious histological characteristics.

• b)

  GDM placentas are heavier than non-GDM placentas

• c)

  GDM placentas have an increased placental to fetal ratio compared to non-GDM placentas

• d)

  Poor glycaemic control correlates well with more significant changes in GDM placentas

• e)

  The main histological findings in GDM placentas are villous fibrinoid necrosis, villous immaturity, chorangiosis and ischaemic changes.

Placental effect on fetal outcome can be explained by which of the following?

• a)

  Increased fetal weight causing higher metabolic need which is responsible for the heavier placenta

• b)

  Histological changes in the GDM placentas causing an increased intervillous diffusion distance which interferes with normal gas and nutrient exchange

• c)

  Diabetic infants compensate for villous immaturity by increasing the placental exchange surface

• d)

  Changing placental angiogenesis increases the risk of hypertensive disease in GDM pregnancies

• e)

  Treatment of GDM normalizes placental changes

Which of the following is/are true relating to GDM pathogenesis?

• a)

  Unlike non-diabetic pregnant women, GDM women have a decrease in insulin sensitivity.

• b)

  Maternal post-prandial hypoglycemia is the result of fetal use of glucose.

• c)

  In normal pregnancy, the fetus favours glycogen as its main energy source.

• d)

  GDM is characterized as an “accelerated starvation” state.

• e)

  Free fatty acid levels are decreased in normal pregnancy in order to favour glucose transport to the fetus.

The great obstetrical syndromes are characterized by which of the following?

• a)

  Multiple aetiologies that may lead to one clinical disease

• b)

  Evolving changes, starting with no clinical appearance and reaching the threshold of clinical disease later in gestation

• c)

  Obstetric diseases that share placental involvement as part of their aetiology.

• d)

  Problems principally involving the maternal compartment only

• e)

  Treatments that should be directed to every disease separately

Metabolomics in the great obstetrical syndrome field have which of the following characteristics?

• a)

  They are invasive

• b)

  They have close biological proximity to the phenotype of the system

• c)

  They allow rapid observation of perturbations in the system

• d)

  They are not suitable for the study of infants

• e)

  They are useful in prevention and monitoring of diseases

Experimental studies have shown that fetal nutritional issues can cause which of the following?

• a)

  They may increase the risk of future chronic pathologies

• b)

  They can reversibly alter the metabolic processes of the fetus and predispose to the development of childhood diseases exclusively

• c)

  A lack of uniformity in findings regarding future outcomes of malnourished fetuses

• d)

  They do not involve metabolic fetal alterations

• e)

  Both excessive and insufficient nutrition may permanently alter the metabolic processes of the fetus.

The following statement(s) is/are true about the concept of the microbiome?

• a)

  The microbiome is the genomes of microorganisms and their hosts of a particular environment, and the relationships between them.

• b)

  Of the microorganisms comprising human microbiomes, 90% are estimated as uncultivable.

• c)

  Metagenomics is studied by bacterial cultures.

• d)

  The 16S rRNA gene is not suitable for PCR amplification, due to its absence in some bacteria.

• e)

  The 16S rRNA gene has both highly conserved and heterogenic sequences

Which of the following statements about the vaginal microbiome of healthy reproductive-age women is/are true?

• a)

  Groups of bacterial clusters have been found to be associated according to ethnic groups.

• b)

  Lactobacillus is a necessary characteristic of healthy vaginal flora.

• c)

  The intra-individual differences in the vaginal microbiome of reproductive-age women are minor.

• d)

  The inter-individual differences in the vaginal microbiome of reproductive-age women are minor within the same ethnic group.

• e)

  The reproductive-age vaginal microbiome is shown to have higher stability than other bodily habitats.

The following statement(s) is/are true about the microbiome and adverse obstetric outcomes?

• a)

  Bacterial ascent from the vaginal tract to the uterus was not found to be a primary source of intrauterine infection.

• b)

  The presence of bacteria in the uterine cavity does in itself cause preterm labour.

• c)

  There is a shorter amniocentesis-to delivery interval among women who were PCR positive for bacteria in the amniotic fluid.

• d)

  Presence of bacteria in the fetal membranes of women who delivered preterm or term, with labour, was associated with a thinner chorion.

• e)

  Presence of bacteria in the fetal membranes of women who delivered preterm or term, without labour, was associated with a thinner chorion

According to the Freinkel Hypothesis (Fuel Mediated Teratogenesis), which of the following statements is/are true?

• a)

  During the third trimester, intrauterine growth restriction can be a primary factor leading to “fuel-mediated teratogenesis”.

• b)

  During the third trimester, organ malformation can be a primary factor leading to “fuel-mediated teratogenesis”.

• c)

  During the second trimester, altered nutritional metabolic states may lead to behavioural, intellectual or psychological damage in the offspring.

• d)

  During the third trimester, altered nutritional metabolic states may be responsible for the development of obesity, hypertension and non-insulin diabetes mellitus later in life.

• e)

  During the third trimester, long term medical sequelae can be set up by the abnormal proliferation of fetal erythrocytes.

According to the Pedersen Hypothesis of Fetal Hyperinsulinemia, which of the following statements is/are true?

• a)

  In the first trimester, an improvement in maternal carbohydrate tolerance was observed lasting 2–3 months.

• b)

  In the second trimester, an improvement in maternal carbohydrate tolerance was observed lasting 2–3 months.

• c)

  By the end of pregnancy, insulin dosage raising is necessary to decrease adverse maternal complications.

• d)

  By the end of pregnancy, insulin dosage raising is necessary to decrease adverse fetal complications.

• e)

  In the third trimester, a decrease in tolerance lasting for an average of two months led to an increase in diabetic pre-coma and acute acidosis.

According to the Barker Hypothesis (Fetal Origins of Adult Disease Hypothesis – Programming and Imprinting In-Utero), which of the following statements is/are true?

• a)

  Decreased maternal IGF (Insulin-like growth factors) will eventually lead to reduced rates of fetal growth.

• b)

  Mortality rates from ischaemic heart disease later in life were higher in small for gestation neonates.

• c)

  Babies who weighted > 4.3kg at birth, were more likely to develop different consequential long-term diseases such as ischaemic heart disease, hypertension and diabetes.

• d)

  Small trunk babies due to in-utero under nutrition had a higher incidence of long-term medical diseases.

• e)

  Small trunk babies due to in-utero hypoxia had a higher incidence of long-term medical diseases.

According to the Nicolaides Hypothesis – The Inverted Pyramid of Pregnancy Care, which of the following statements is/are true?

• a)

  A combination of maternal demographic and haemodynamic characteristics can determine the prediction of future development of PET in up to 60% of pregnancies

• b)

  Maternal serum markers can help determine the prediction of future development of PET

• c)

  Maternal factors and biomarkers at 11 to 13 weeks have the potential to identify the subsequent development of GDM in about 75% of pregnancies

• d)

  Maternal factors and biomarkers at 11 to 13 weeks have a false positive rate of 5% for the prediction of subsequent development of GDM

• e)

  Maternal biophysical and biochemical markers as early as 11–13 weeks can identify a higher tendency of small for gestational age fetuses in up to 75% of pregnancies

Multiple regression analysis is used to develop predictive models describing risks for pre-eclampsia. Which of the following is/are true regarding these models?

• a)

  They are effective in screening for gestational hypertension

• b)

  They include assessment of the umbilical artery Doppler

• c)

  They define baseline risk through demographic factors

• d)

  They include measurement of maternal mean arterial blood pressure

• e)

  They are primarily based on measurement of multiple maternal serum samples

Based on meta-analysis of published trials, which of the following is/are true regarding Aspirin in relation to pre-eclampsia?

• a)

  It should not be prescribed until the third trimester of pregnancy

• b)

  It is reportedly associated with drug resistance when given in lower doses

• c)

  It is most effective when prescribed at night

• d)

  It reduces rates of late onset pre-eclampsia

• e)

  It is associated with a significant risk of maternal GI haemorrhage

The following is/are true regarding Gestational diabetes:

• a)

  It is becoming increasingly prevalent in all ethnic groups

• b)

  Diagnostic bias is responsible for trends in the disease incidence

• c)

  It is associated with increased rates of metabolic syndrome in the infants of affected mothers

• d)

  It is associated with higher rates of type II diabetes in later life

• e)

  It is best diagnosed by measurement of fasting serum glucose at 20 weeks gestation

Which of the following is/are true regarding first trimester screening for gestational diabetes?

• a)

  It is currently recommended for all pregnant women

• b)

  It should be offered to all primigravida women

• c)

  It has been shown to detect 90% of affected pregnancies for a 5% false positive rate

• d)

  It may best be provided using an algorithm with multiple parameters

• e)

  Most screening tests include a glucose challenge test

The O’Sullivan and Mahan criteria for GDM

• a)

  Are based on a randomized trial

• b)

  Were derived from their association with future risk of diabetes

• c)

  Are widely used outside the USA

• d)

  Were derived from a cohort of over 3000 women

• e)

  Have been superseded by HbA1c measurements

Concerning the Crowther and Landon RCTs for GDM therapy:

• a)

  Both studies showed an improvement in composite endpoints with GDM therapy

• b)

  The patients in the Crowther study were more severely hyperglycemic

• c)

  Quality of life was worse with GDM treatment in the Crowther study

• d)

  Both studies showed a reduction in pre-eclampsia with treatment of GDM

• e)

  The frequency of large for gestational age (LGA) babies was reduced by active treatment in both studies

Which evaluation types and outcome measures would be appropriate to help decide which GDM screening program should be implemented in order to conduct a local health economic evaluation from a health care perspective?

• a)

  CEA using found cases of GDM

• b)

  CUA using QALY

• c)

  CEA using cases of permanent brachial plexus injury

• d)

  CEA using a composite outcome combining neonatal and maternal morbidity and mortality

• e)

  CBA using monetary units

Which of the following evaluation types and outcome measures would be appropriate for the analysis of a health economic evaluation on GDM screening?

• a)

  CEA using found cases of GDM

• b)

  CUA using QALY

• c)

  CEA using cases of permanent brachial plexus injury

• d)

  CEA using a composite outcome combining neonatal and maternal morbidity and mortality

• e)

  CBA using monetary units

Which of the following characteristics of a new screening program will increase the need for resources for screening in your department compared to the existing program?

• a)

  The new screening program being universal testing for all women

• b)

  The new screening program using a lower diagnostic threshold limit

• c)

  The new screening-program being risk-based, but the definition of risk factors for GDM being expanded

• d)

  The new screening program applying a test with longer duration than the existing program (i.e. 3h OGTT)

• e)

  The new screening program applying diagnostic criteria depending on hourly measurement of blood glucose

The following is/are true regarding MicroRNA?

• a)

  It is involved in quenching

• b)

  It is involved in coding RNA

• c)

  It is involved in transcriptional silencing

• d)

  It is involved in ubiquitination

• e)

  It is involved in methylation

Which of the following is/are true regarding placental derived microRNA?

• a)

  The placental microRNA expression pattern is constant during pregnancy

• b)

  About 20 microRNAs have been reported to be dysregulated in pre-eclampsia

• c)

  About 15% of microRNAs reported to be dysregulated in pre-eclampsia were named in at least two independent studies

• d)

  Variation in microRNA expression is most likely the result of different RNA extraction protocols

• e)

  Variation in microRNA expression has been demonstrated in large studies

Which of the following is/are true regarding miR-210?

• a)

  MiR-210 appears to be the most highly expressed microRNA in trophoblast cells and in placental tissue.

• b)

  MiR-210 is connected with pre-eclampsia appearance.

• c)

  MiR-210 has a role in trophoblast activity.

• d)

  Severe pre-eclampsia patients show higher miR-210 levels.

• e)

  Ectopic expression of miR-210 induces trophoblast migration.

Which of the following is/are true regarding early detection of pre-eclampsia and GDM?

• a)

  Cell-free fetal (cff) DNA levels are usually low in pre-eclampsia.

• b)

  C-peptide in early amniocentesis showed promising preliminary results in GDM detection.

• c)

  MiR-29a, connected with obesity, is dysregulated in GDM women

• d)

  MiR-222, connected with obesity, is dysregulated in GDM women.

• e)

  Placental microRNAs are found in very low concentration in maternal blood.

The following is/are true regarding macrosomia?

• a)

  Macrosomia is uniquely defined by a birth weight greater than 4 kg.

• b)

  A relationship between maternal glycaemia and fetal growth exists

• c)

  Macrosomia is by itself a risk factor associated with neonatal complications

• d)

  Macrosomia is exclusively a consequence of maternal diabetes

• e)

  Macrosomia bears consequences only during the neonatal period

Concerning complications in newborns to diabetic mothers:

• a)

  The incidence of fetal malformation is increased in cases of gestational diabetes mellitus.

• b)

  Neonates born to women with diabetes have an increased risk of respiratory distress syndrome (RDS).

• c)

  The principal mechanism of RDS relies in altered lung surfactant synthesis, directly due to fetal hyperglycemia.

• d)

  The impact of maternal diabetes is low in developing countries.

• e)

  Infants born to diabetic mothers are at increased risk of non-communicable diseases later in life.

Hypoglycaemia during the neonatal period:

• a)

  Should be screened for in all babies from diabetic mothers.

• b)

  Can be prevented by simple measures at birth.

• c)

  Is more frequent in macrosomic babies.

• d)

  Needs in all cases to be treated with IV glucose.

• e)

  Breastfeeding has beneficial effects on the risk of long-term obesity

The following maternal pathophysiological changes that may link pregnancy complications with future cardiovascular events can be documented at the time of diagnosis of pregnancy complications:

• a)

  Elevated circulating levels of soluble cell adhesion molecules

• b)

  Cardiac biventricular diastolic dysfunction

• c)

  Increased carotid intima-media thickness

• d)

  Carotid atherosclerotic plaques

• e)

  Elevated triglycerides