28 year old pregnant woman with no known medical condition comes for first prenatal visit. You notice her to have fasting blood glucose level of 144mg / dL and 3 + Glycosuria. How do you counsel her about risk of fetal anomalies

**Core Concept**
The patient's fasting blood glucose level of 144mg/dL and 3+ glycosuria suggest gestational diabetes mellitus (GDM), a condition characterized by high blood glucose levels during pregnancy. The primary concern with GDM is the increased risk of fetal macrosomia and congenital anomalies.

**Why the Correct Answer is Right**
Gestational diabetes is associated with an increased risk of congenital anomalies, particularly those involving the heart and limbs. This is due to the teratogenic effects of hyperglycemia, which can disrupt fetal development. The risk of congenital anomalies is highest in the first trimester, and early detection and management of GDM are crucial to minimize this risk.

**Why Each Wrong Option is Incorrect**
* **Option A:** This option is incorrect because hyperlipidemia, while a concern in GDM, is not directly related to the risk of fetal anomalies.
* **Option B:** This option is incorrect because while obesity is a risk factor for GDM, it is not a direct cause of fetal anomalies.
* **Option C:** This option is incorrect because hypertension, although a concern in pregnancy, is not directly related to the risk of fetal anomalies in GDM.

**Clinical Pearl / High-Yield Fact**
It is essential for healthcare providers to screen for GDM between 24-28 weeks of gestation, as early detection can help minimize the risk of fetal anomalies and other complications.

**Correct Answer:**
.

✓ Correct Answer: C. She has four - fold higher risk of having child with congenital anomalies.