RN Nursing · Prenatal Care · Practice question
An NP is managing a patient who is attempting to conceive. When assessing for potential risk, which of the following places this patient at a moderate or high risk for neural tube defects (NTDs)?
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A body mass Index under 25.
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✓
The presence of pregestational diabetes.
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A history of NTD in a fourth degree relative.
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A diet high in leafy greens and legumes.
Answer & explanation
Correct: The presence of pregestational diabetes.
Pregestational diabetes — meaning diabetes mellitus (type 1 or type 2) that was present before pregnancy — is a well-established moderate-to-high risk factor for neural tube defects. Poorly controlled diabetes causes elevated glucose levels during early embryogenesis, particularly during the critical period of neural tube closure between weeks 3 and 4 of gestation. Hyperglycemia is teratogenic and significantly increases the risk of NTDs, congenital heart defects, and other structural anomalies. Patients with pregestational diabetes are typically advised to take higher doses of folic acid (4 mg/day rather than the standard 0.4 mg/day) before and during early pregnancy to reduce NTD risk. A body mass index under 25 is in the normal, healthy range and does not confer elevated NTD risk; obesity (BMI over 30) is associated with increased risk. A history of NTD in a fourth-degree relative is too distant a family relationship to place a patient at moderate or high risk — the risk becomes clinically relevant with first- or second-degree relatives affected. A diet high in leafy greens and legumes is actually protective, as these foods are rich in naturally occurring folate, which is essential for neural tube closure. Therefore, pregestational diabetes is the correct answer as it places the patient at meaningful elevated risk for NTDs.
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