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Osteoporosis screening — MCCQE Part 1 MCQ

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ModeratePreventive MedicineOsteoporosis screeningMCCQE Part 1

A patient whose previous pregnancy was affected by spina bifida plans to conceive again in six months. She takes no folate antagonist and has no contraindication to supplementation. Which folic-acid plan is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Begin 4 mg daily at least three months before conception and continue through 12 weeks

A previous neural-tube-defect-affected pregnancy places her in a high-recurrence-risk group. Canadian clinical guidance recommends 4 mg of folic acid daily beginning at least three months before conception and continuing through the first 12 weeks, when neural-tube closure occurs, followed by an appropriate standard prenatal supplement plan. This higher dose should be prescribed and reviewed rather than achieved by taking several multivitamins, which can cause excessive exposure to other ingredients such as vitamin A. Food fortification and the routine 0.4 mg dose are important for population prevention but are insufficient for this specific high-risk history. Preconception review should also optimize medications, diabetes or malabsorption if present and arrange prenatal screening.

Reference: Government of Canada Pregnancy Clinical Practice Support: https://www.canada.ca/en/department-national-defence/services/benefits-military/health-support/women-diversity-health/womens-health-care-clinicians/pregnancy-clinical-practice-support-administrative-processes.html