Potential Bias: Due to being 40, she would like to be done having kids.

Potential Bias: Because her other pregnancies were healthy, she does not know how to eat properly for her diagnosis of gestational diabetes.

Recommendation: Education! Providing information on pros/cons of further pregnancies as well as pros/cons for having tubes tied.

Recommendation: Provide examples of balanced meals, glucose friendly recommendation and potentially a meal plan to help with glucose management.

Recommendation: Education on periodontal disease and pregnancy risk and oral hygiene Instruction for mother and infant oral care including potential risk for nursing or bottle caries, oral care for her infant to reduce risk of gross caries, and first dental appointment recommendations.

Potential Bias: assuming she does not know mother and infant oral care from previous pregnancies.

Recommendation: 3-month care dental cleaning interval to remove pathogens and debridement of supporting structures of her teeth causing periodontal disease.

Potential bias: not recommending the 3-month care interval because it is not covered by her insurance and assuming she will not pay out of pocket for the recommended cleaning.

Potential Bias: This pregnancy was unplanned/unintended.

Potential Bias: Assuming Debora will struggle to adhere to a proper diet plan.

Recommendation: Provide consistent follow up care to help her keep track of meals, manage glucose levels, answer questions, and ensure the well being of both mother and baby.