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Answer
B. Folic acid
The image shows a fetus with anencephaly - a severe neural tube defect (NTD) where the cranial vault and brain tissue are absent, leaving exposed, necrotic neural tissue over the head/neck region. This is one of the most severe NTDs.
Why folic acid (B)?
Periconceptional folic acid supplementation is the single most effective intervention to reduce NTD recurrence:
- Standard prevention dose: 0.4-0.5 mg/day for all women of reproductive age
- After a previously affected pregnancy (HIGH RISK): 4-5 mg/day starting at least 1 month before conception and continuing through the first 12 weeks of pregnancy
- This high-dose regimen reduces NTD recurrence risk by ~70%
Why not the others?
| Option | Role |
|---|---|
| Vitamin B12 (A) | B12 deficiency can raise homocysteine and contribute to NTD risk, but supplementing B12 alone is NOT the primary prevention strategy |
| Iron (C) | Prevents iron-deficiency anemia; no role in NTD prevention |
| Vitamin D (D) | Bone/immune health; no established role in NTD prevention |
Key teaching point: Any woman who has had a pregnancy affected by an NTD (anencephaly, spina bifida, encephalocele) should receive high-dose folic acid 5 mg/day preconceptionally in all future pregnancies. This is a standard exam and clinical guideline recommendation (WHO, ACOG, RCOG).
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