A newly diagnosed nsulin-dependent type 1 idiabetic with good blood sugar control is at 20 weeks' gestation. She asks the nurse how her diabetes will affect her baby. The best explanation would include:
1. "Your baby could 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. "Your baby might have high blood sugar for several days."
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.
Rationale 2: The infant of a diabetic mother produces excessive amounts of insulin in response to the high blood sugar. This hyperinsulinism stimulates growth (or macrosomia) in the infant because the infant utilizes the glucose in the bloodstream.
Rationale 3: The demands of pregnancy will make it difficult for the best of patients to control blood sugar on a regular basis.
Rationale 4: Within minutes of delivery, the baby of an insulin-dependent diabetic can begin to have low blood sugar.
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