A woman arrives at the clinic for her annual examination. She tells the nurse that she thinks she has a vaginal infection and has been using an over-the-counter cream for the past 2 days to treat it. The nurse's initial response should be to:

Choice A reason: Vascular volume increases during pregnancy to meet the increased oxygen and nutrient demands of the fetus, not to compensate for decreased renal plasma flow. In fact, renal plasma flow increases by 50% to 80% during pregnancy to facilitate the excretion of metabolic wastes.

Choice B reason: Vascular volume increases during pregnancy to ensure adequate blood supply to the uterus and other organs, not to prevent maternal and fetal dehydration. Dehydration can occur due to vomiting, diarrhea, or inadequate fluid intake, and it can be prevented by drinking enough fluids and replacing electrolytes.

Choice C reason: Vascular volume increases during pregnancy to provide adequate perfusion of the placenta, which is the main organ of gas exchange and nutrient delivery for the fetus. The placenta receives about 10% of the maternal cardiac output at term.

Choice D reason: Vascular volume increases during pregnancy to support the growth and development of the fetus and the maternal tissues, not to eliminate metabolic wastes of the mother. Metabolic wastes are eliminated by the kidneys, lungs, skin, and gastrointestinal tract.

Choice A reason: Low birth weight is not a common complication of GDM, as the fetus tends to grow larger than normal due to the excess glucose and insulin in the blood. Low birth weight is more likely to occur in infants of mothers with preexisting diabetes or other conditions that affect placental function.

Choice B reason: Preterm birth is a possible complication of GDM, as the increased fetal size and the risk of maternal hypertension or infection may induce labor before term. However, it is not the greatest risk for the fetus, as preterm infants can survive with proper care and treatment.

Choice C reason: Macrosomia is the greatest risk for the fetus of a mother with GDM, as it is defined as a birth weight of more than 4000 g or 8 lb 13 oz. Macrosomia can cause difficulties during labor and delivery, such as shoulder dystocia, birth trauma, or cesarean birth. It can also increase the risk of neonatal hypoglycemia, jaundice, or respiratory distress.

Choice D reason: Congenital anomalies of the central nervous system are not a common complication of GDM, as they usually occur in the first trimester of pregnancy, before GDM is diagnosed or develops. Congenital anomalies are more likely to occur in infants of mothers with preexisting diabetes or other genetic or environmental factors.