A nurse is providing preconception counseling to a 29-year-old that has Diabetes Mellitus, Type II and who is planning a pregnancy within the next 6 months. Which of the following is the nurse's most important recommendations for the woman to reduce the risks of pregestational diabetes? Select all that apply

A. While preterm infants are at increased risk for hypoglycemia due to limited glycogen stores and immature metabolic regulation, dexamethasone does not directly prevent hypoglycemia. Its pharmacologic action is not related to neonatal blood sugar management.

B. Dexamethasone is a corticosteroid given to pregnant clients at risk of preterm birth, typically between 24 and 34 weeks gestation. The medication crosses the placenta and stimulates fetal lung epithelial cells to produce surfactant, a substance that reduces alveolar surface tension, enabling the lungs to remain open for effective gas exchange after birth. By accelerating lung development, dexamethasone significantly reduces the risk of respiratory distress syndrome (RDS), intraventricular hemorrhage, necrotizing enterocolitis, and neonatal mortality. The most benefit is observed when delivery occurs 24–48 hours after the first dose but within 7 days of administration.

C. While corticosteroid therapy can have secondary benefits, including a reduction in intraventricular hemorrhage, this is not the primary purpose of dexamethasone administration. The main goal remains enhancing fetal lung maturity.

D. Dexamethasone is not a tocolytic and does not suppress preterm labor contractions. Tocolytic medications, such as magnesium sulfate, nifedipine, or indomethacin, are used for short-term suppression of uterine activity to allow time for corticosteroids to enhance fetal lung maturity.

A. Fetal hypoxia is typically indicated by abnormal FHR patterns, such as late decelerations, decreased or absent variability, bradycardia, or prolonged decelerations. In this scenario, the FHR shows a normal baseline, moderate variability, and accelerations, all of which suggest adequate oxygenation and fetal well-being.

B. Tachycardia is defined as a baseline FHR greater than 160 beats per minute. Causes of fetal tachycardia can include maternal fever, infection, medications, or fetal hypoxia, but this fetus has a baseline of 135 bpm, which is within the normal range of 110–160 bpm, so tachycardia is not present.

C. Bradycardia is defined as a baseline FHR less than 110 beats per minute. Causes of bradycardia can include prolonged cord compression, maternal hypotension, or congenital heart conditions, but this fetus has a baseline of 135 bpm, ruling out bradycardia.

D. This fetus exhibits a reassuring FHR pattern characterized by a normal baseline indicating adequate cardiac function, moderate variability reflecting an intact autonomic nervous system and good oxygenation, presence of accelerations demonstrating a responsive, well-oxygenated fetus, and absence of decelerations, indicating there is no evidence of uteroplacental compromise or cord compression.