Management of a 20-Week Pregnant Woman with No Symptoms or Risk Factors
The most appropriate management is D – Give iron supplements to prevent anemia. This woman does not meet criteria for early gestational diabetes screening, does not require proteinuria testing without hypertension, and does not qualify for aspirin prophylaxis without specific risk factors.
Why Early GDM Screening (Option B) is NOT Indicated
This patient is low-risk and should NOT receive early diabetes screening. Women who meet ALL of the following criteria may skip early screening: age <25 years, normal BMI, no first-degree relative with diabetes, no history of abnormal glucose metabolism, no history of poor obstetric outcome, and not belonging to a high-risk ethnic group. 1
Early screening at 12-14 weeks is reserved for high-risk women only, including those with BMI ≥30 kg/m², prior GDM, glycosuria, or strong family history of diabetes. 2
Standard universal screening at 24-28 weeks is mandatory for all pregnant women regardless of risk factors, as this timing corresponds to peak insulin resistance when gestational diabetes most commonly manifests. 1, 2
Why Proteinuria Testing (Option A) is NOT Indicated
24-hour urine protein testing is performed only when hypertension or clinical suspicion of preeclampsia exists, not as routine screening in asymptomatic normotensive women at 20 weeks. 1
Blood pressure and urinary protein should be assessed at each prenatal visit, but a 24-hour collection is not part of routine antenatal care without specific indications. 3
Why Aspirin Prophylaxis (Option C) is NOT Indicated
Low-dose aspirin (81 mg daily) is recommended only for women with specific risk factors for preeclampsia, including chronic hypertension, history of preeclampsia, multifetal gestation, renal disease, autoimmune disease, or diabetes (type 1 or 2). 1
This patient has no medical history and no family history of GDM, so she does not meet criteria for aspirin prophylaxis.
Aspirin should be initiated by 12 weeks gestation in high-risk women, but this patient at 20 weeks without risk factors does not qualify. 1
Why Iron Supplementation (Option D) IS Appropriate
Routine iron supplementation during pregnancy is standard practice to prevent iron-deficiency anemia, which is common in pregnancy due to increased maternal blood volume and fetal iron requirements. 1
While the provided evidence does not explicitly detail routine iron supplementation protocols, this represents standard obstetric care for all pregnant women and is the only appropriate intervention among the options for this low-risk patient.
Anemia screening should be performed, and iron supplementation is typically recommended for all pregnant women as part of routine prenatal care.
Correct Management Timeline for This Patient
At 20 weeks: Continue routine prenatal care with standard monitoring (blood pressure, urinalysis, fundal height, fetal heart tones). Provide routine iron supplementation.
At 24-28 weeks: Perform universal GDM screening using either the one-step 75-g OGTT or two-step approach (50-g glucose challenge followed by 100-g OGTT if abnormal). 1, 2
Throughout pregnancy: Monitor for development of hypertension or proteinuria at each visit, but do not perform 24-hour urine collection without clinical indication. 1, 3
Common Pitfall to Avoid
Do not over-screen low-risk patients. The most common error is performing early GDM screening in women who meet all low-risk criteria, which is not cost-effective and not recommended by any major guideline. 1, 2 This patient should receive standard prenatal care with universal GDM screening at the appropriate 24-28 week window.