Which factor is known to increase the risk of gestational diabetes mellitus?

Choice A reason: Eating five small meals daily can help reduce heartburn in pregnancy by preventing overeating and reducing the pressure on the stomach from the growing uterus. It can also help maintain a steady blood glucose level and prevent nausea and vomiting.

Choice B reason: Lying down after each meal can worsen heartburn in pregnancy by allowing the stomach acid to reflux into the esophagus. It can also cause breathing difficulties and increase the risk of aspiration. The woman should avoid lying down for at least two hours after eating and elevate her head and chest when sleeping.

Choice C reason: Reducing the amount of fiber she consumes can cause constipation and hemorrhoids in pregnancy, which can increase the discomfort and pain. Fiber is important for maintaining a healthy digestive system and preventing gestational diabetes and preeclampsia. The woman should consume at least 25 grams of fiber per day from fruits, vegetables, whole grains, beans, and nuts.

Choice D reason: Substituting other calcium sources for milk in her diet can deprive the woman and the baby of essential nutrients, such as protein, vitamin D, and riboflavin. Milk is not a common cause of heartburn in pregnancy, unless the woman is lactose intolerant or allergic to dairy products. The woman should consume at least three servings of dairy products per day or take calcium supplements as prescribed.

Choice A reason: The NST has no known contraindications, as it is a non-invasive and safe test that does not stimulate uterine contractions or cause fetal distress. It is the most widely used method of antepartum fetal surveillance.

Choice B reason: The NST is not slightly more expensive than the CST, as it requires less time and equipment. The NST usually takes 20 to 40 minutes, while the CST may take up to 2 hours. The NST only needs a fetal monitor, while the CST also needs an intravenous line and oxytocin infusion.

Choice C reason: The NST does not have fewer false-positive results than the CST, as it has a higher rate of nonreactive results that may indicate fetal compromise when there is none. A nonreactive NST is one that does not show at least two accelerations of the fetal heart rate of 15 beats per minute or more lasting 15 seconds or more in a 20-minute period.

Choice D reason: The NST is not more sensitive in detecting fetal compromise than the CST, as it has a lower predictive value for fetal well-being. A reactive NST is one that shows at least two accelerations of the fetal heart rate of 15 beats per minute or more lasting 15 seconds or more in a 20-minute period. However, a reactive NST does not rule out the possibility of fetal hypoxia or acidosis.