A nurse is completing a health history for a client who is at 6 weeks of gestation. The client informs the nurse that she smokes one pack of cigarettes per day. The nurse should advise the client that smoking places the client's newborn at risk for which of the following complications?

A. Hearing loss in newborns is typically associated with genetic factors, congenital infections (e.g., CMV), or exposure to ototoxic medications. Maternal smoking has not been shown to directly cause hearing deficits, though it can indirectly affect overall fetal development. B. Congenital heart defects are linked to genetic mutations, maternal diabetes, or teratogenic exposures (like certain medications or alcohol). Cigarette smoking has not been strongly correlated with structural heart anomalies. C. Type 1 diabetes mellitus is an autoimmune disorder with genetic predisposition. Maternal smoking does not increase the risk of autoimmune diabetes in offspring. D. Intrauterine growth restriction (IUGR) is a well-documented risk of maternal smoking. Nicotine and carbon monoxide reduce placental blood flow and oxygen delivery, impairing fetal nutrient supply, which can result in low birth weight, preterm birth, and increased neonatal morbidity.