The client with insulin-dependent type 2 diabetes and an HbA1c of 5% is planning to become pregnant soon. What anticipatory guidance should the nurse provide this client?
1. Vascular disease that accompanies diabetes slows progression.
2. The risk of ketoacidosis decreases during the length of the pregnancy.
3. The baby is likely to have a congenital abnormality because of the diabetes.
4. Insulin needs decrease in the first trimester and increase during the third trimester.
4
Explanation:
1. Vascular disease progresses more rapidly during pregnancy, especially if blood sugar control is not good. Problems such as nephropathy and retinopathy can result.
2. The risk of ketoacidosis increases during pregnancy.
3. Infants of diabetic mothers have a 5% to 10% greater risk of having a congenital abnormality. This risk increases to 20% to 25% if the HbA1c is over 10%.
4. In addition, insulin requirements drop suddenly after delivery of the placenta.
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