A pregnant client with gestational diabetes mellitus (GDM) is at risk for which of the following maternal complications?

• PROM (Premature Rupture of Membranes): PROM refers to the rupture of membranes before the onset of labor and before 37 weeks of gestation. This client is at 28 weeks with confirmed membrane rupture and no contractions, making this the most accurate diagnosis.
• Preterm labor: Preterm labor is defined as regular uterine contractions with cervical change before 37 weeks. This client denies contractions, and the cervix is closed, so she does not meet the criteria for preterm labor at this time.
• Preeclampsia: Preeclampsia typically presents with new-onset hypertension (≥140/90 mm Hg) after 20 weeks of gestation, often with proteinuria or other signs of organ involvement. This client’s blood pressure is within normal limits, and there are no signs of proteinuria or significant symptoms of preeclampsia.
• Rupture of membranes at 28 weeks: The client reports 12 hours of clear vaginal leakage, and tests (positive nitrazine and ferning) confirm rupture of membranes. Since this occurred at 28 weeks, it represents preterm rupture and is directly linked to PROM.
• Uterine cramping at 28 weeks : The client specifically denies experiencing cramping or contractions. Without uterine activity or cervical change, there is no evidence to support uterine cramping or preterm labor.
• Blood pressure elevated at 140/90 mm Hg: The client’s recorded blood pressure is 108/84 mm Hg, which is within the normal range for pregnancy. There is no indication of elevated blood pressure or other signs that would suggest hypertensive complications.

A. Occupation: While a woman’s job may influence exposure to stress or hazards, it is not the most significant factor affecting maternal health. Its impact varies greatly and is often tied to broader issues like income and healthcare access.

B. Level of education: Education can affect health literacy and decision-making, but it is not the strongest determinant of maternal health outcomes. Its effects are indirect and often mediated through other factors like healthcare access and socioeconomic status.

C. Access to prenatal care: Timely and consistent prenatal care enables early detection and management of pregnancy complications, improving both maternal and fetal outcomes. Lack of access contributes to higher rates of morbidity and mortality, making it a key determinant in the U.S.

D. Marital status: Marital status may influence emotional and financial support, but it does not consistently predict maternal health outcomes. Access to care and quality of services play a more direct role in determining maternal well-being.