A 20-year-old client is at 18 weeks gestation. Her prenatal history reveals past drug abuse, and urine screening indicates that she has recently used cocaine. The nurse should recognize that the client is at increased risk for which condition(s)? (Select all that apply.)

Choice A rationale Cocaine is a potent vasoconstrictor that causes a rapid increase in maternal blood pressure and significant uterine artery constriction. This sudden vascular compromise can lead to premature separation of the placenta from the uterine wall, known as placenta abruption. This condition is a life-threatening emergency for both the mother and the fetus due to the risk of severe hemorrhage and impaired fetal oxygenation caused by the drug's sympathetic nervous system stimulation. Choice B rationale Erythroblastosis fetalis is a hemolytic disease of the newborn that occurs due to Rh incompatibility between the mother and the fetus. It involves the maternal immune system producing antibodies that attack fetal red blood cells. There is no known scientific or physiological link between the use of cocaine and the development of Rh isoimmunization or hemolytic anemia. This condition is strictly related to blood group antigens rather than substance abuse or maternal vasoconstriction. Choice C rationale The systemic effects of cocaine involve the inhibition of norepinephrine reuptake at nerve endings, leading to a state of chronic sympathetic overactivity. This results in persistent vasoconstriction and increased peripheral vascular resistance, which manifests as gestational hypertension. The cardiovascular strain placed on the mother by regular cocaine use increases the likelihood of developing preeclampsia or other hypertensive disorders of pregnancy, which can have devastating effects on maternal organ systems and placental perfusion. Choice D rationale Cocaine use during pregnancy causes chronic intrauterine hypoxia due to decreased blood flow through the placental bed. When the fetus is deprived of adequate oxygen and essential nutrients over a long period, growth is significantly restricted. This often results in the infant being small for gestational age at birth. The vasoconstrictive properties of the drug limit the transfer of glucose and amino acids, which are necessary for normal fetal weight gain and development. Choice E rationale Substance abuse is frequently associated with various lifestyle factors, including poor nutritional intake. Cocaine acts as a powerful appetite suppressant, which often leads to the mother neglecting her caloric and vitamin requirements. Inadequate maternal nutrition further compounds the risks to the fetus, as the lack of essential building blocks like folic acid, iron, and protein can lead to anemia, low birth weight, and other developmental complications during the gestation period.