The nurse is teaching a client about chorionic villus sampling prior to the procedure.
Which client statement(s) indicates that the teaching was effective? (Select all that apply).

Choice A rationale

Macrosomia, or excessive birth weight, is a common complication of maternal diabetes, but it is typically a concern in the second and third trimesters. It occurs due to fetal hyperinsulinemia in response to high maternal glucose levels. At 7 weeks gestation, the fetus is in the embryonic stage, and the primary physiological process is organogenesis rather than rapid weight gain or fat deposition. Therefore, while macrosomia is a significant risk later in pregnancy, it is not the priority fetal concern during the first trimester.

Choice B rationale

At 7 weeks gestation, the embryo is undergoing organogenesis, the critical period when major organs are formed. A glycosylated hemoglobin (HbA1C) of 8.9 percent (normal range typically below 5.7 percent) indicates poor glycemic control in the weeks leading up to and during early pregnancy. High glucose levels are teratogenic during this window, significantly increasing the risk of major congenital anomalies, particularly cardiac defects and sacral agenesis. Establishing euglycemia early is vital to reduce the risk of structural malformations during these formative weeks.

Choice C rationale

Cephalopelvic disproportion (CPD) occurs when the fetal head is too large to pass through the maternal pelvis, often as a result of fetal macrosomia. Like macrosomia, this is a concern at the end of pregnancy and during the labor process. At 7 weeks gestation, the embryo is only a few millimeters long, and the physical dimensions relative to the birth canal are irrelevant. The focus during the first trimester must be on the viability and structural integrity of the developing embryo rather than delivery complications.

Choice D rationale

Hyperbilirubinemia is a neonatal complication that occurs after birth. It is often seen in infants of diabetic mothers due to polycythemia and the subsequent breakdown of excess red blood cells. While maternal hyperglycemia during pregnancy contributes to this risk, it is not a concern that can manifest or be addressed at 7 weeks gestation. The priority at this early stage is the prevention of developmental errors that could lead to miscarriage or permanent structural birth defects.

Choice A rationale

Vitamin B12 is essential for nerve function and the production of red blood cells, but it is not specifically indicated as an additional supplement for a patient solely based on a history of ventricular septal defect (VSD) repair. Most pregnant women receive adequate B12 through standard prenatal vitamins or diet. Unless the patient follows a strict vegan diet or has a malabsorption issue, B12 supplementation is not the primary focus for managing the hematological demands of pregnancy.

Choice B rationale

Iron supplementation is critical for a pregnant client with a history of ventricular septal defect repair. Pregnancy naturally increases blood volume, and a history of cardiac repair requires optimal oxygen-carrying capacity to prevent strain on the heart. Iron is a key component of hemoglobin, which carries oxygen to tissues. Maintaining a normal hemoglobin level (12 to 16 g/dL) prevents anemia, which could otherwise lead to increased cardiac output and potential heart failure in a patient with a pre-existing cardiac history.

Choice C rationale

Vitamin C is important for collagen synthesis and helps with the absorption of iron, but it is not typically prescribed as a standalone additional supplement for cardiac patients in pregnancy. While it is beneficial, the standard amount found in prenatal vitamins is usually sufficient. The priority for a patient with a repaired VSD is ensuring the blood can carry enough oxygen, which is more directly addressed by iron levels rather than the antioxidant properties of Vitamin C.

Choice D rationale

Calcium is vital for fetal bone development and maternal bone health, but it does not have a specific therapeutic benefit related to the history of a ventricular septal defect repair. While all pregnant women need adequate calcium intake to prevent maternal bone demineralization, it does not directly impact the hemodynamic stability or the oxygenation needs of a patient with a cardiac history in the same way that iron supplementation does during the high-demand state of pregnancy.