Which of the following is a common complication associated with poorly managed gestational diabetes mellitus?

RRB Nsg. Superintendent-2026 (Shift -1st)

Obstetrics & Gynecology

Easy

Appeared in: RRB Nsg. Superintendent-2026 (Shift -1st)

Explanation

Macrosomia, defined as a birth weight greater than 4 kg or above the 90th percentile, is a hallmark complication of poorly controlled gestational diabetes.
The underlying cause is maternal hyperglycemia, which leads to excess glucose transfer across the placenta to the fetus.
This fetal hyperglycemia stimulates the fetal pancreas to produce excess insulin (fetal hyperinsulinemia).
Insulin acts as a primary growth hormone in the fetus, leading to excessive growth of somatic tissues and fat deposition, resulting in macrosomia.

Option A: Hyperemesis gravidarum (severe nausea and vomiting) is a complication of early pregnancy, often linked to high hCG levels, and is not caused by GDM.
Option C: Placenta previa is an abnormal implantation of the placenta over the cervical os. Its risk factors include advanced maternal age, multiparity, and prior cesarean sections, but not GDM.
Option D: While the risk of preterm labor is increased in pregnancies complicated by diabetes (often due to associated conditions like polyhydramnios or preeclampsia), macrosomia is the most direct fetal consequence of the metabolic derangement (hyperglycemia) itself.

Visual 1: Flowchart - Pathophysiology of macrosomia. This visual should illustrate the sequence: Maternal Hyperglycemia → Glucose crosses placenta → Fetal Hyperglycemia → Fetal Pancreatic Hyperplasia & Hyperinsulinemia → Increased Fetal Growth (Macrosomia).

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Complications of Gestational Diabetes Mellitus (GDM) as background academic context rather than a clinical decision trigger.
Nurses play a critical role in managing GDM by educating patients on diet, exercise, and blood glucose self-monitoring to prevent macrosomia.
A macrosomic fetus increases the risk of birth complications, including shoulder dystocia (a medical emergency), birth trauma (e.g., clavicle fractures, brachial plexus injury), and the need for a cesarean delivery.
What if the baby is born to a mother with poorly controlled GDM? The nurse must anticipate and immediately monitor the newborn for hypoglycemia. The maternal glucose supply is cut off at birth, but the infant's hyperinsulinemia persists, causing a rapid drop in their blood sugar.

How to Approach the Question

First, identify the core condition in the question stem: 'poorly managed gestational diabetes mellitus'.
Next, analyze the keyword 'complication'. This requires recalling the effects of GDM on both the mother and the fetus.
Focus on the pathophysiology. Remember that in GDM, maternal glucose freely crosses the placenta, but maternal insulin does not.
Consider the fetal response: the fetus produces its own insulin to manage the high glucose load. Insulin is a growth hormone.
Evaluate the options based on this mechanism. Excessive fetal insulin leads to excessive fetal growth.
Connect 'excessive fetal growth' to the correct medical term among the options, which is 'Macrosomia'.

Concept Tested & Keywords

Concept Tested: Complications of Gestational Diabetes Mellitus (GDM)
Stem keywords: common complication, poorly managed, gestational diabetes mellitus
Lead-in keywords: Which of the following
Clinical cues: poorly managed
Negative lead-in flag: false

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