A nurse is teaching a client who is at 23 weeks of gestation about immunizations. Which of the following statements should the nurse include in the teaching?

Choice A reason: Reducing stress level is a good practice for a pregnant client, as it can lower the risk of complications such as preterm labor, hypertension, and low birth weight. Therefore, this statement does not indicate a need for further teaching.

Choice B reason: Using only nonprescription medications while pregnant is a dangerous and incorrect practice, as some over-the-counter drugs can harm the fetus or cause birth defects. The client should always consult with their doctor before taking any medication, whether prescription or nonprescription. Therefore, this statement indicates a need for further teaching.

Choice C reason: Monitoring weight gain during pregnancy is a recommended practice, as it can help the client and the doctor assess the health and growth of the fetus. The client should follow the guidelines for appropriate weight gain based on their pre-pregnancy body mass index (BMI). Therefore, this statement does not indicate a need for further teaching.

Choice D reason: Telling the doctor before using home remedies for nausea is a prudent practice, as some herbal or natural remedies can interact with medications or cause adverse effects on the fetus. The client should also avoid self-medication and seek medical advice for persistent or severe nausea. Therefore, this statement does not indicate a need for further teaching.

Choice A reason: Congenital anomalies of the central nervous system are not a common complication of GDM, as they usually occur in the first trimester, before GDM develops. However, GDM can increase the risk of other congenital anomalies, such as cardiac defects or neural tube defects.

Choice B reason: Preterm birth is a possible complication of GDM, as it can be caused by maternal hypertension, preeclampsia, or placental abruption. However, it is not the most likely complication, as GDM can also delay the onset of labor and prolong the pregnancy.

Choice C reason: Low birth weight is not a typical complication of GDM, as it is more associated with intrauterine growth restriction (IUGR), which is caused by placental insufficiency. GDM can cause the opposite problem, which is excessive fetal growth.

Choice D reason: Macrosomia is the most common complication of GDM, as it is defined as a birth weight of more than 4,000 grams (8.8 pounds). It is caused by the excess glucose crossing the placenta and stimulating the fetal insulin production, which leads to increased fat deposition and organ enlargement. Macrosomia can increase the risk of birth trauma, shoulder dystocia, and neonatal hypoglycemia.