A nurse is providing teaching to a client who is planning on becoming pregnant about the changes she should expect. Identify the sequence of maternal changes.

Order from the first in appearance to last.

Choice A rationale

High-protein, low-carbohydrate diets are not recommended during pregnancy as they can lead to ketone production, which may harm fetal development. A balanced diet is crucial for maternal and fetal health.

Choice B rationale

Although breastfeeding can help with postpartum weight loss, it is not advisable to use pregnancy as a reason to overeat. Healthy weight gain during pregnancy is essential for fetal development.

Choice C rationale

Gaining 1 lb (0.5 kg) per week is recommended during the second trimester for a client with a normal BMI to ensure proper fetal growth and development.

Choice D rationale

Exercise is beneficial, but it cannot prevent all weight gain during pregnancy. Appropriate weight gain is necessary for fetal health and development.

The correct sequence of maternal changes from first to last is:

1. Amenorrhea (A) – This is usually the first sign of pregnancy, occurring due to increased progesterone levels and the absence of a menstrual period.
2. Goodell’s sign (B) – This refers to the softening of the cervix, which typically occurs around 6-8 weeks of pregnancy due to increased vascularization.
3. Quickening (C) – This is the first perception of fetal movement by the mother, usually felt between 16-20 weeks of pregnancy.
4. Lightening (D) – This occurs late in pregnancy (around 37-40 weeks) when the fetus descends into the pelvis in preparation for birth.

So, the correct order is:
A → B → C → D.