Maternal health: preconception folic acid: practice question

A PSM question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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PSM · Maternal health: preconception folic acid

Sample item

A 27-year-old woman who previously delivered a baby with a neural tube defect plans another pregnancy. What folic acid advice is correct?

A4 mg daily only after 12 weeks of gestationB400 micrograms daily starting after the first antenatal visitCNo supplement is needed if her diet is goodDHigh-dose 4 to 5 mg daily starting at least one month before conception until 12 weeks

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. High-dose 4 to 5 mg daily starting at least one month before conception until 12 weeks

A previous neural tube defect raises the recurrence risk to about 2 to 5% in a later pregnancy, and high-dose folic acid started before conception reduces it markedly. The neural tube closes by about 28 days after conception, so supplementation must begin before pregnancy is recognised and continue to 12 weeks. Women without such a history take 400 micrograms daily.

Option by option

A. 4 mg daily only after 12 weeks of gestation
Beginning after 12 weeks misses the period of neural tube closure.
B. 400 micrograms daily starting after the first antenatal visit
400 micrograms is the dose for average-risk women and starting after the first visit is too late.
C. No supplement is needed if her diet is good
Diet alone does not give enough folate to prevent recurrence in a high-risk woman.
D. High-dose 4 to 5 mg daily starting at least one month before conception until 12 weeks (correct)
Correct. High-dose preconception supplementation lowers recurrence of neural tube defects.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this PSM question

What is the answer to this PSM question?

The best answer is D, High-dose 4 to 5 mg daily starting at least one month before conception until 12 weeks. A previous neural tube defect raises the recurrence risk to about 2 to 5% in a later pregnancy, and high-dose folic acid started before conception reduces it markedly.

Why is "4 mg daily only after 12 weeks of gestation" not the answer?

Beginning after 12 weeks misses the period of neural tube closure.

Why is "400 micrograms daily starting after the first antenatal visit" not the answer?

400 micrograms is the dose for average-risk women and starting after the first visit is too late.

Why is "No supplement is needed if her diet is good" not the answer?

Diet alone does not give enough folate to prevent recurrence in a high-risk woman.

What concept does this question test?

It tests Maternal health: preconception folic acid in PSM. The neural tube closes by about 28 days after conception, so supplementation must begin before pregnancy is recognised and continue to 12 weeks. Women without such a history take 400 micrograms daily.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Maternal health: preconception folic acid?

Practise biostatistics with small calculations until sensitivity, predictive values and risk measures are automatic. Then use the flashcards and the other PSM questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.