A newly diagnosed type 1, well-controlled, insulin-dependent diabetic client at 20 weeks' gestation asks the nurse how her diabetes will affect her baby. The best explanation would include:
1. "Your baby might be smaller than average at birth."
2. "Your baby will probably be larger than average at birth."
3. "As long as you control your blood sugar, your baby will not be affected at all."
4. "There are no effects until about 2 hours after birth, when your baby might have low blood sugar."
2
Rationale:
1. Poorly controlled type 1 diabetics who have developed vascular problems will have infants who are small for gestational age (SGA) due to placental insufficiency.
2. The infant produces excessive amounts of insulin—hyperinsulinism. This affects the infant in that he utilizes the glucose in the bloodstream, stimulating growth—macrosomia.
3. The demands of pregnancy will make it difficult for the best of clients to control blood sugars on a regular basis.
4. Within minutes of delivery, the baby of a type 1 diabetic can begin to have blood sugar problems.
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