A client with a body mass index (BMI) of 32 asks the nurse about the potential risks during pregnancy.

The nurse explains that an elevated BMI increases the risk of developing:.

The correct answer is choice A. A 32-year-old woman who is obese and has PCOS.

This woman has two major risk factors for developing gestational diabetes: obesity and polycystic ovary syndrome (PCOS).Obesity increases insulin resistance and PCOS is associated with hormonal imbalances that affect glucose metabolism.

Choice B is wrong because being Asian and having a previous baby who weighed 4 kg (8.8 lb) at birth are not as strong risk factors as obesity and PCOS.However, they do increase the risk slightly.

Choice C is wrong because being Caucasian and having impaired glucose tolerance are also not as strong risk factors as obesity and PCOS.Impaired glucose tolerance means that the blood sugar level is higher than normal but not high enough to be diagnosed as diabetes.

Choice D is wrong because being Hispanic and having a parent with type 2 diabetes are also not as strong risk factors as obesity and PCOS.However, they do increase the risk slightly.

Normal ranges for blood glucose levels during pregnancy are:

• Fasting: less than 95 mg/dL

• One hour after meal: less than 140 mg/dL

• Two hours after meal: less than 120 mg/dL

The correct answer is choice A. The nurse should monitor the woman’s blood glucose levels every hour during labor.This is because maternal blood glucose levels around the time of delivery are directly related to the risk of neonatal hypoglycemia.Therefore, achieving maternal euglycemia in women with gestational diabetes mellitus is critical to decreasing the risk of neonatal complications.

Choice B is wrong because every two hours is not frequent enough to ensure optimal glucose control during labor.

Choice C is wrong because every four hours is even less frequent and may miss significant fluctuations in blood glucose levels.

Choice D is wrong because every six hours is too infrequent and may put the mother and the baby at risk of adverse outcomes.

The maternal glucose should be maintained between 4.0 and 6.0-7.0 mmol/L during labor.Most women with gestational diabetes, especially if they require less than 1.0 units/kg/d of insulin, can simply be monitored without intravenous insulin.However, women who are taking medication for gestational diabetes require more frequent glucose monitoring, typically with hourly evaluations.