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Pre-conception folic acid — DRCOG MCQ

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HardAntenatal CarePre-conception folic acidDRCOG

A woman with type 2 diabetes seeks preconception advice. HbA1c is 68 mmol/mol, and she takes metformin, ramipril and atorvastatin. Which plan best reduces preventable pregnancy risk before conception?

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

Reveal the answer and explanation

Correct answer: E — Prescribe folic acid 5 mg daily, optimise glucose and replace ramipril and atorvastatin before attempting conception

Explanation lettering: C = shown as B · B = shown as C · E = shown as D · D = shown as E

D is correct. NICE advises folic acid 5 mg daily while planning pregnancy through 12 weeks, improving HbA1c toward the preconception target, and stopping or replacing renin–angiotensin-system blockers and statins before pregnancy. Metformin may continue when its glycaemic benefit outweighs potential harm. E uses standard-dose folate and delays ACE-inhibitor action. A retains a statin and postpones the antihypertensive change far into pregnancy. B uses inadequate folate and removes useful glucose-lowering treatment. C starts folate after the preventive window has begun and preserves two medicines requiring preconception review. Retinal and renal assessment, ketone and glucose-monitoring plans, weight and smoking advice, and rapid contact after conception complete the pathway.

Reference: NICE NG3: Diabetes in pregnancy—recommendations: https://www.nice.org.uk/guidance/ng3/chapter/recommendations