A nurse is teaching a client at 24 weeks of gestation about special considerations of gestational diabetes mellitus (GDM). Which of the following statements by the client indicates the teaching was effective? (Select all that apply.)

Choice A rationale Gestational Diabetes Mellitus (GDM) increases the risk of fetal compromise, including uteroplacental insufficiency and poor glucose control, particularly in the third trimester. Therefore, antenatal surveillance, such as the Non-Stress Test (NST), is essential after 32-34 weeks of gestation to monitor fetal well-being, assessing fetal heart rate accelerations as an indicator of adequate oxygenation and central nervous system function. Choice B rationale A history of GDM significantly increases the client's risk of developing Type 2 diabetes mellitus (T2DM) later in life, not Type 1 diabetes. T2DM is characterized by insulin resistance and relative insulin deficiency, and the risk is estimated to be 35-60% within 10-20 years postpartum due to underlying metabolic predispositions exacerbated by pregnancy. Choice C rationale GDM is associated with an increased risk of polyhydramnios (excess amniotic fluid) due to fetal hyperglycemia-induced polyuria, and is also linked to subclinical infection/inflammation. Both factors can contribute to overdistention of the uterus and subsequent irritability and preterm labor, necessitating careful monitoring and timely management to prolong gestation. Choice D rationale Fetal hyperinsulinemia resulting from maternal hyperglycemia leads to fetal macrosomia (birth weight >4000 g), which is a common complication of GDM. Macrosomia increases the risk of uterine overdistention during pregnancy. The overstretched myometrium is often less effective at contracting post-delivery, increasing the client's risk of postpartum hemorrhage (PPH) due to uterine atony. Choice E rationale While GDM can cause significant emotional distress, and screening for postpartum depression is routine, there is no specific, mandatory consultation with a psychiatrist solely due to the diagnosis of GDM. Management typically involves consultation with an endocrinologist (or maternal-fetal medicine specialist), a dietitian, and an obstetrician for glucose control and pregnancy monitoring. .