On her first visit, a patient had a baseline hemoglobin of 13.0 gm and a hematocrit of 42.9%.She has been taking ferrous sulfate tablets and eating an iron-rich diet.She returned to the clinic at 30 weeks gestation and has a hemoglobin of 11.0 gm and a hematocrit of 36.3%.She is concerned and confused about why these lab values have gone down.
In responding, which physiological change during pregnancy should the nurse describe to the patient?

The correct answer is choice A. A patient who weighed less than 5 lb (2,268 gm) at birth is at risk for having an infant with intrauterine growth retardation (IUGR).This is because low birth weight is a possible indicator of genetic factors or placental insufficiency that can affect fetal growth.

Choice B is wrong because an ectopic pregnancy one year ago does not increase the risk of IUGR.An ectopic pregnancy is when the fertilized egg implants outside the uterus, usually in the fallopian tube.It does not affect the placental function or fetal development in a subsequent pregnancy.

Choice C is wrong because a mitral valve prolapse does not increase the risk of IUGR.

A mitral valve prolapse is when the valve between the left atrium and left ventricle of the heart does not close properly.It usually does not cause any symptoms or complications during pregnancy, unless it is associated with severe regurgitation or arrhythmias.

Choice D is wrong because the father’s age of 42 years old does not increase the risk of IUGR.The father’s age may affect the risk of chromosomal abnormalities or congenital anomalies in the fetus, but not the fetal growth.

Some of the other risk factors for IUGR include maternal smoking, alcohol, or drug use, medical conditions like anemia or lupus, infections such as rubella or syphilis, carrying twins or multiples, high blood pressure, gestational diabetes, and placenta problems.

The correct answer is choice C.Adolescents need more protein than older pregnant women because they are still growing themselves and need to support the growth of the baby and the placenta.Protein can be found in meat, poultry, fish, eggs, dairy products, beans, nuts, and fortified cereals.

Choice A is wrong because adolescents need more supplemental iron than older women, not less.This is because they have lower iron stores due to rapid growth and menstruation.Iron deficiency can cause anemia and increase the risk of infections and bleeding.Iron can be found in meat, poultry, fish, eggs, dairy products, beans, nuts, and fortified cereals.

Choice B is wrong because adolescents need more carbohydrates than older women, not less.Carbohydrates provide energy for the mother and the baby and spare protein for other functions.Carbohydrates can be found in grains, fruits, vegetables, and dairy products.

Choice D is wrong because adolescents need the same amount of vitamin C as older pregnant women, which is 85 milligrams per day.Vitamin C helps with wound healing, collagen formation, iron absorption, and immune function.Vitamin C can be found in citrus fruits, tomatoes, peppers, broccoli, potatoes, and fortified juices.