Which statement by a pregnant client at week 18 of pregnancy indicates a need for further investigation?

The statement expressing dissatisfaction with one's appearance, particularly stating, "I don't like my face anymore. I always look like I have been crying," reveals potential emotional or psychological distress that warrants further investigation. During pregnancy, especially around the 18th week, hormonal changes can lead to various physical transformations, which might affect a woman's self-perception. Concerns about one's appearance that are accompanied by feelings of sadness or low self-worth can indicate issues such as prenatal depression or anxiety. These conditions may not only impact the mother's well-being but can also affect fetal development and postpartum adjustment.

In contrast, the other statements reflect more typical and positive experiences of pregnancy. Feeling healthier than ever and expressing excitement about the upcoming baby are signs of a positive emotional state. Additionally, the admission of sleeping well aligns with good physical and mental health, which is critical during pregnancy. Hence, the concern expressed in the selected statement stands out as needing further assessment to ensure both the mother's and the baby's health.