A 29-week gestation client with gestational diabetes should have which planning discussed?

• A. Plan induction at 35 weeks.
• B. Plan amniocentesis at this time.
• C. Schedule a biophysical profile immediately.
• D. Plan for weekly nonstress tests at 32 weeks.

Answer: (D)

Gestational diabetes increases the risk of fetal hypoxia or growth complications as the pregnancy progresses, so the plan emphasizes ongoing fetal surveillance rather than immediate delivery or invasive testing. Nonstress testing is a noninvasive way to check fetal well-being by monitoring for heart rate accelerations in response to movement, which indicates adequate oxygenation and nervous system function. Starting surveillance with weekly nonstress tests around 32 weeks provides timely information about the fetus’s status during the late preterm to term period and allows for timely action if responses become nonreactive. If the test is reactive, continued weekly testing is generally appropriate; if it’s nonreactive, additional evaluations (like a biophysical profile) would be considered. Inducing delivery at 35 weeks is not routinely planned in a stable GDM pregnancy, and amniocentesis at 29 weeks isn’t indicated without specific reasons.