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  #1  
Old 04-18-2012
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Zygote Maternal Folate and Neural Tube Defects?

Neural tube defects in the fetus are most closely associated with maternal folate deficiency during which point in time?

a) prior to conception
b) first trimester
c) second trimester
d) third trimester
e) first few months after birth

Last edited by johndoe3344; 04-18-2012 at 09:28 AM.
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  #2  
Old 04-18-2012
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Answer is A
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Old 04-18-2012
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Answer is B
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Old 04-18-2012
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If I remember my gynae rotation, I think it would be the second trimester, while fetal brain development is taking place most rapidly.

This is also the time period when exposure to teratogens have the highest impact on neurological functions.
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Old 04-18-2012
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I have seen this type of question in Goljan Studentconsult Q-bank and the correct answer was Prior to pregnancy QID: 108179.


As They explain taking Folate and Iron during pregnancy is required for normal hematopoiesis in the fetus, but Folic acid must be present in adequate amounts before pregnancy to prevent open neural tube defects.
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Old 04-18-2012
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will go with B, not sure
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Old 04-18-2012
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B) First trimester.

The neural tube closes around week 4. Mom needs to maintain good folate levels during neural tube development, between weeks 0-4. Once you get past that point, it doesn't matter anymore... if the neural tube is closed, it's closed; if it's open, it's open.

You can even detect a neural tube defect with AFP levels around weeks 9-12.

See First Aid 2012 page 133.
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Old 04-18-2012
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i guess B.
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Old 04-18-2012
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Should be B
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  #10  
Old 04-18-2012
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b i think...

neural tube closes completely by 21st day. so makes sense to start supplementing folate as soon as possible.

2beka-cts.

i hear you... hmm... if you are wrong (UC wrong) than i would conclude that their qbank has too many mistakes...
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Old 04-18-2012
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Well, you usually start folate supplementation prior to conception in women who are trying to get pregnant just to make sure that you don't miss the 4-week window. So maybe that's what the UC question said.

But you don't need that folate until the first 3-4 weeks of pregnancy.
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Old 04-20-2012
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Hi Guys.
I just have payed attention to this:




If interested check Goljan RR page 209 J-2
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  #13  
Old 04-20-2012
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Default A

It's A. I think they mentioned somewhere that it's a tricky type of question. It might have been Goljan in one of the lectures but I'm not 100% sure...

@johndoe3344: what's the answer?
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Old 04-20-2012
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Quote:
Originally Posted by Casandra View Post
It's A. I think they mentioned somewhere that it's a tricky type of question. It might have been Goljan in one of the lectures but I'm not 100% sure...

@johndoe3344: what's the answer?


I'm 100+ % sure that this was Goljan ... Check in RR
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Old 04-20-2012
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Quote:
Originally Posted by beka-CTS View Post
I'm 100+ % sure that this was Goljan ... Check in RR
G for God of every tricky question = Goljan DD

@beka-CTS: hahaha I just saw your post. didn't see it when I was putting mine <lol>

Last edited by Casandra; 04-20-2012 at 07:37 AM. Reason: typo
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  #16  
Old 04-20-2012
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Preconceptional folate therapy..
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  #17  
Old 04-20-2012
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Quote:
Originally Posted by Casandra View Post
It's A. I think they mentioned somewhere that it's a tricky type of question. It might have been Goljan in one of the lectures but I'm not 100% sure...

@johndoe3344: what's the answer?
Not sure what the answer is. Pathoma says A) but I learned B) previously.
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Quote:
Originally Posted by johndoe3344 View Post
Not sure what the answer is. Pathoma says A) but I learned B) previously.
pathoma + goljan = highest point of reliability
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Old 04-20-2012
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Default never ever forget this

choice A

its always pre-conceptional ...

all the rest r wrong...
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  #20  
Old 05-21-2012
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Default Another Proof Of The Answer

So i found this one in Goljan too, but in Gestational disoders:

[/url]
jpg upload

You can check Goljan RR Page 466: F. 2.
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  #21  
Old 05-21-2012
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Guys, finally to cut it short....the neural tube close by 25-28 day, before even the mother recognize that she is pregnant (most women come to know that they are pregnant when they miss there monthly period)....so, any female during childbearing period must have adequate folate stores and even receive folate supplements.

So, the answer is 100% A

Source: Kaplan embryology
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  #22  
Old 05-21-2012
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I go with A
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  #23  
Old 05-21-2012
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i cant accept A

B is the answer & pls can you give us the answer and source.

i have a question for those that choose A.so every lady that gets pregnant with low folate has a baby with neural tube defect?
Organogenesis is b/w 3-8wks GA.and thats when you folate def.can harm the embryo.
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  #24  
Old 05-21-2012
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Default Precaution is better then cure.

I would go with A too.
As someone explained earlier. embryogenesis take place in 3-8 weeks and in that period of time most ladies don't know about there pregnancy status. So folate levels should be in normal limits before pregnancy.
And regarding that question: will every lady with less folate will give birth to baby with neural tube defect.
According to me. Then are certainly more chances of baby having neural tube defect but nothing can be so sure. As not all babies with HIV+ mom have HIV virus but they have more chances to get HIV. (Sorry reference is not so adequate but hope you guys got my point.
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A clearly, I was fooled by Usmle Consult.

Thanks Beka-CTS for rugged explanation
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  #26  
Old 05-21-2012
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@koolkiller

you definitly dont get my point.
if a parturient with low FA is started on hematinics at 1st trimester,they definitly do well with no abnormality in the fetus but if its started in 2nd tri.the damage is already done so its the management in 1st trimester that matters.

& for your HIV correlation to this;babies born by hiv +ve mothers have 98% chance of being +ve if no antiviral was used/vertex delivery.
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Old 05-21-2012
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I agree

Quote:
Originally Posted by beka-CTS View Post
I have seen this type of question in Goljan Studentconsult Q-bank and the correct answer was Prior to pregnancy QID: 108179.


As They explain taking Folate and Iron during pregnancy is required for normal hematopoiesis in the fetus, but Folic acid must be present in adequate amounts before pregnancy to prevent open neural tube defects.
Agree, same reason why Folate prophylaxis has to begin pre conception in mothers at risk. That's what we do in practice- give folate when they say they are planning for a pregnancy.
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  #28  
Old 05-24-2012
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now what is the right answer??
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