Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The client's elevated blood sugar levels during her current pregnancy, combined with the fact that she only exhibits these signs while pregnant, fits the precise definition of GDM. Her history of delivering a macrosomic infant (weighing 4536 g, which is >4000 g) is a significant risk factor for and a common clinical indicator associated with GDM in a previous pregnancy.

A. Insulin-dependent diabetes: This is an outdated term describing treatment (the need for insulin) rather than the underlying pathophysiology or type of diabetes.

B. Type II diabetes mellitus: This is a chronic metabolic disorder that persists outside of pregnancy. The scenario specifies the client only shows signs of diabetes when she is pregnant.

C. Type I diabetes mellitus: This is an autoimmune condition resulting in absolute insulin deficiency that would be present before, during, and after pregnancy, not just during gestation.

1. American Diabetes Association. (2022). 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2022. Diabetes Care, 45(Supplement1), S17–S38. https://doi.org/10.2337/dc22-S002

Page S27, Section "Gestational Diabetes Mellitus": Defines GDM as "diabetes diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes prior to gestation."

2. American College of Obstetricians and Gynecologists (ACOG). (2018). ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstetrics & Gynecology, 131(2), e49-e64. https://doi.org/10.1097/AOG.0000000000002501

Page e50, "Background" section: Lists risk factors for GDM, including a "history of delivering an infant weighing 4,000 g or more."

3. Ricci, S. S., Kyle, T., & Carman, S. (2021). Maternity and pediatric nursing (4th ed.). Wolters Kluwer.

Chapter 21, "Nursing Management of the Pregnancy at Risk: Selected Health Conditions and Vulnerable Populations," Section "Diabetes Mellitus": Differentiates between pregestational diabetes (Type 1 or Type 2) and gestational diabetes, defining the latter as glucose intolerance that does not extend beyond the pregnancy.