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Chapter 69. Pregnancy and Lactation

A 30-year-old woman wants to start vitamins before she becomes pregnant sometime next year. She takes acetaminophen for headaches, her vaccines are current, and she consumes about 600 mg of caffeine per day. Which component of a multivitamin will decrease the risk of neural tube defects in her baby?

a. Calcium

b. Iron

c. Vitamin D

d. Folic acid

Answer d is correct: Adequate intake of folic acid decreases the incidence of neural tubal defects by 50% to 70%. Neural tube defects can occur in the first 4 weeks of development. It is important that all women of childbearing age take 400 to 800 mcg of folic acid daily. Some women with a higher risk of a pregnancy affected by neural tubal defects may require 4 mg daily.

Answer a is incorrect: Calcium plays an important role in bone health. A fetus will require 30 grams of calcium for a full term pregnancy. Recommended daily calcium intake is 1300 mg for ages 14 to 18 years and 1000 mg for women 19 to 50 years.

Answer b is incorrect: Iron is important to support the increase in red cell mass, expanded plasma volume, and the growth of the fetal-placental unit. The Centers for Disease Control and Prevention (CDC) recommends 27 to 30 mg of elemental iron daily.

Answer c is incorrect: Adequate vitamin D is important for maintaining the proper amount of calcium and phosphorus for healthy bones and teeth.

A 30-year-old woman wants to start vitamins before she becomes pregnant sometime next year. She takes acetaminophen for headaches, her vaccines are current, and she consumes about 600 mg of caffeine per day. If the patient does become pregnant, which vaccines are safe to administer during pregnancy? Select all that apply.

a. Varicella

b. Measles, mumps, rubella (MMR)

c. Tetanus, diphtheria, acellular pertussis (Tdap)

d. Human papilloma virus (HPV)

e. Influenza (inactivated)

Answer c is correct. Tdap should be given with each pregnancy.

Answer e is correct. Inactivated influenza vaccine is safe during all trimesters.

Answer a is incorrect. Varicella is a live vaccine; due to the theoretical risk of transmission to the fetus, live vaccines should be avoided during pregnancy unless the benefit of receiving the vaccine outweighs the risk.

Answer b is incorrect. MMR is a live vaccine; due to the theoretical risk ...

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