A nurse is teaching a pregnant client who has diabetes mellitus about the risk of having a baby with macrosomia.

Which of the following statements by the client indicates a need for further teaching?

“I should expect to have a cesarean section because vaginal delivery is too risky.” This statement indicates a need for further teaching because it is not true that all women with diabetes mellitus and macrosomia need to have a cesarean section.

The mode of delivery depends on several factors, such as the estimated fetal weight, the maternal pelvic size, the fetal position, and the presence of any complications.

The nurse should explain to the client that vaginal delivery may be possible if the conditions are favorable and the risks are low.

Choice A is wrong because it is a correct statement.

Women with diabetes mellitus should monitor their blood glucose levels closely and follow their prescribed diet to prevent hyperglycemia and fetal macrosomia.

Choice B is wrong because it is also a correct statement.

Women with diabetes mellitus and macrosomia should have regular prenatal visits and ultrasounds to monitor their baby’s growth and well-being.

Choice D is wrong because it is another correct statement.

Women with diabetes mellitus and macrosomia should be aware of the signs of hypoglycemia in their baby after birth, such as jitteriness, lethargy, poor feeding, and low temperature.

The baby may need glucose supplementation or intravenous fluids to maintain normal blood glucose levels.

Normal ranges:

• Blood glucose levels: 70-110 mg/dL (3.9-6.1 mmol/L) for fasting; <140 mg/dL (<7.8 mmol/L) for postprandial

• Estimated fetal weight: 2500-4000 g (5.5-8.8 lb) for term

Feed the newborn formula or breastmilk as prescribed.This is because newborns with macrosomia (large birth weight) are at risk of hypoglycemia (low blood sugar) due to increased insulin production in response to high glucose levels in the womb.Formula or breastmilk provide adequate glucose and nutrients to prevent or treat hypoglycemia.

Choice B is wrong because glucose water does not provide enough calories or protein for growth and development.

Choice C is wrong because honey or corn syrup can cause infant botulism, a serious infection that affects the nervous system.

Choice D is wrong because rice cereal or oatmeal are not appropriate for newborns, as they can cause choking, allergies, or overfeeding.

Normal ranges for blood glucose levels in newborns are 40 to 150 mg/dL (2.2 to 8.3 mmol/L).Newborns with a suspected or confirmed genetic hypoglycemia disorder have a lower threshold of 70 mg/dL (3.9 mmol/L).