A nurse is reviewing the laboratory results of a pregnant woman who is being screened for gestational diabetes.

The nurse notes that the woman has a fasting blood glucose level of 100 mg/dL.

Which of the following actions should the nurse take?

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 check the newborn’s blood glucose level within one hour after birth.This is because newborns of mothers with gestational diabetes are at risk of developing hypoglycemia due to hyperinsulinemia.Hypoglycemia can cause neurological damage or death if not treated promptly.

Choice B is wrong because two hours may be too late to detect and treat hypoglycemia in a newborn at risk.

Choice C is wrong because three hours is definitely too late to check the blood glucose level of a newborn at risk of hypoglycemia.

Choice D is wrong because four hours is way too late to check the blood glucose level of a newborn at risk of hypoglycemia.

The normal blood glucose level for a newborn is between 70 and 150 mg/dL.However, some infants may have transient low blood glucose levels as low as 25 mg/dL within the first two hours of life, which is physiologic and self-limited.Infants with risk factors for hypoglycemia, such as maternal diabetes, should be screened at 2 hours of age and then before each feeding for the first and second days of life.A blood glucose level of less than 45 mg/dL in an asymptomatic infant or less than 36 mg/dL in a symptomatic infant is considered hypoglycemic and requires treatment.