**Question:** Which of the following comes under high risk category for screening GDM?

A. Overweight/Obesity (BMI > 25 kg/m²)
B. Family history of Diabetes Mellitus
C. Pregnancy after the age of 35 years
D. Pregnancy after the age of 40 years

**Correct Answer: D.** Pregnancy after the age of 40 years

**Core Concept:** GDM stands for Gestational Diabetes Mellitus, a type of diabetes that develops during pregnancy when the woman was previously not diagnosed with diabetes. Screening for GDM helps identify women who are at higher risk for developing chronic diabetes later in life and also for potential complications during pregnancy.

**Why the Correct Answer is Right:** Women who become pregnant after the age of 40 years are at a higher risk for developing GDM due to several factors:

1. **Advanced maternal age:** Older maternal age is associated with insulin resistance and a higher risk of developing GDM. The risk increases significantly beyond the age of 40 years.
2. **Decreased fertility:** Women over 40 years may have a decreased fertility rate, which makes them more likely to conceive after the age of 40 years.
3. **Changes in insulin sensitivity and secretion:** Advanced maternal age is associated with alterations in insulin sensitivity and secretion, which can contribute to the development of GDM.

**Why Each Wrong Option is Incorrect:**

A. **Overweight/Obesity (BMI > 25 kg/m²):** Although obesity is a risk factor for developing GDM, the question specifies the category of high-risk patients, which is pregnant women who are already diagnosed with GDM. This option is not a high-risk category for screening GDM.

B. **Family history of Diabetes Mellitus:** Although a family history of diabetes increases the risk of GDM, the question asks for a high-risk category for screening, which is not specified in this option.

C. **Pregnancy after the age of 35 years:** This option focuses on advanced maternal age, which is correct, but it does not specify the high-risk category for screening GDM (i.e., pregnant women). For the sake of clarity, we will refer to the correct answer as "Option D, Pregnancy after the age of 40 years."

**Clinical Pearl:** A thorough understanding of risk factors for GDM, along with knowledge of the high-risk category for screening, is crucial for healthcare professionals providing prenatal care. Identifying pregnant women in the high-risk category allows healthcare providers to initiate appropriate interventions, monitor glucose levels more frequently, and provide necessary counseling and support to these women and their families. Early detection and management of GDM can reduce potential complications for both the mother and the baby during pregnancy, labor, and postpartum.