A nurse is reinforcing teaching with a client about how to reduce the risk of giving birth to a newborn who has a neural tube defect. Which of the following instructions should the nurse include in the teaching?

Adequate folic acid intake before and during early pregnancy is the most evidence-based intervention for reducing the risk of neural tube defects (NTDs) such as spina bifida and anencephaly. Neural tube closure occurs very early in embryonic development, typically by the 28th day after conception, often before a woman knows she is pregnant. Folic acid is required for DNA synthesis and cell division during this critical period. The Centers for Disease Control and Prevention and other health organizations recommend that women of childbearing age consume 400 to 800 micrograms of folic acid daily through supplements or fortified foods such as cereals, breads, and pasta. This has been shown to reduce the incidence of NTDs by up to 70%. While avoiding alcohol is an important recommendation during pregnancy to prevent fetal alcohol syndrome and other complications, it does not specifically prevent neural tube defects. Increasing iron intake addresses anemia and supports fetal development but is not directly linked to NTD prevention. Avoiding aspirin may be appropriate in some clinical situations but does not reduce NTD risk. Therefore, instructing the client to eat foods fortified with folic acid is the most specific and evidence-based teaching for NTD prevention.