Which data would place a pregnant client at risk for developing gestational diabetes?

• A. The client's last baby weighed 10 pounds at birth.
• B. The client's previous deliveries were by cesarean section.
• C. The client has a family history of cardiovascular disease.
• D. The client is 5 feet, 3 inches tall and weighs 165 pounds.

Answer: (A)

A prior birth weight of about 10 pounds signals gestational diabetes risk because it reflects prior maternal hyperglycemia that affected fetal growth. When a mother has elevated glucose levels during pregnancy, glucose crosses the placenta and stimulates the fetus to produce more insulin, which acts as a growth factor and can lead to a larger baby (macrosomia). A history of delivering a macrosomic infant increases the likelihood that glucose intolerance or diabetes was present in the previous pregnancy, so this data point best identifies a risk for developing gestational diabetes again.

Being overweight is a general risk factor for GDM, but it doesn’t specifically demonstrate a prior episode of glucose intolerance. A cesarean delivery history isn’t a direct predictor of GDM, and a family history of cardiovascular disease isn’t a specific indicator for gestational diabetes.