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: This is incorrect. Decreased production of erythrocytes (red blood cells) is a consequence, not a cause, of iron deficiency anemia. Iron is needed to make hemoglobin, the protein that carries oxygen in the red blood cells. Without enough iron, the body cannot produce enough hemoglobin or red blood cells¹.

Choice B reason: This is correct. Inadequate intake of iron is the most common cause of iron deficiency anemia during pregnancy. Pregnant women need more iron than nonpregnant women to support the increased blood volume and the fetal growth. If the dietary intake of iron is not sufficient, the body will use up its iron stores, leading to iron deficiency anemia.

Choice C reason: This is incorrect. Dilution of hemoglobin concentration is a normal physiological change during pregnancy, not a cause of iron deficiency anemia. The blood volume increases by 20% to 30% during pregnancy, while the red blood cell mass increases by only 15% to 20%. This results in a lower concentration of hemoglobin in the blood, but not necessarily a lower amount of hemoglobin or iron³.

Choice D reason: This is incorrect. The fetus establishing iron stores is not a cause of iron deficiency anemia during pregnancy, although it can contribute to it. The fetus needs iron for its own development and growth, and it obtains iron from the mother through the placenta. The fetal iron demand increases in the second and third trimesters, when the fetus accumulates iron in its liver and other tissues. This can deplete the maternal iron stores, especially if the mother does not consume enough iron.

Choice A reason: Hyperbilirubinemia is incorrect because it is not a major complication of infants of diabetic mothers. It is a condition where the baby has high levels of bilirubin in the blood, which can cause jaundice. It can occur in any newborn, but it is more common in premature babies, babies with blood type incompatibility, or babies with infections.

Choice B reason: Hypoglycemia is correct because it is a major complication of infants of diabetic mothers. It is a condition where the baby has low blood sugar levels, which can cause seizures, lethargy, or poor feeding. It can occur because the baby's pancreas produces too much insulin in response to the mother's high blood sugar levels during pregnancy.

Choice C reason: Hypoinsulinemia is incorrect because it is not a major complication of infants of diabetic mothers. It is a condition where the body does not produce enough insulin, which can cause high blood sugar levels. It can occur in children or adults with type 1 diabetes, but not in newborns of diabetic mothers.

Choice D reason: Hypercalcemia is incorrect because it is not a major complication of infants of diabetic mothers. It is a condition where the baby has high levels of calcium in the blood, which can cause muscle weakness, vomiting, or kidney stones. It can occur in babies with certain genetic disorders, such as Williams syndrome, or babies with hyperparathyroidism, but not in infants of diabetic mothers.