Nutrition in Pregnancy — MCQs
What is the recommended dose of folic acid for a patient with a history of neural tube defect (NTD) in a previous pregnancy?
Average extra caloric requirement during second and third trimesters of pregnancy is:
Dose of vitamin A for an 18 month old baby, with keratomalacia, weighing 10 kg is?
A 32-year-old female at 36 weeks of pregnancy presents with BP 170/100 mmHg, visual disturbances, headache, urine protein 3+. What will be the next step?
Additional protein and calorie requirements in pregnancy are?
What is the recommended dietary allowance of iron during pregnancy?
Which of the following statements about folic acid and vitamin B12 is NOT true?
Which of the following represents the current recommendation for offering screening for Down's syndrome during pregnancy?
What is the obstetric score of a 26-year-old woman who is 36 weeks pregnant, has had one previous delivery of twins, and is certain of her dates?
A pregnant woman comes to the clinic. She has previously delivered twins. What is the correct representation of her obstetric score?
Nutrition in Pregnancy Indian Medical PG Practice Questions and MCQs
Question 1: What is the recommended dose of folic acid for a patient with a history of neural tube defect (NTD) in a previous pregnancy?
- A. 0.5 mg
- B. 1 mg
- C. 2 mg
- D. 4 mg (Correct Answer)
Explanation: ***4 mg*** - For women with a prior history of a **neural tube defect (NTD)-affected pregnancy**, a higher dose of **4 mg of folic acid daily** is recommended to significantly reduce the risk of recurrence. - This increased dosage is crucial for achieving adequate maternal folate levels to prevent NTDs, starting at least one month before conception and continuing through the first trimester. *0.5 mg* - This dose is lower than the standard recommendation for women without a history of NTDs and is insufficient for high-risk individuals. - Suboptimal folic acid levels can still lead to a higher risk of NTD recurrence in patients with a history of NTD-affected pregnancies. *1 mg* - While 1 mg is higher than the general recommendation, it is still insufficient for women with a **history of NTD in a previous pregnancy**. - Current guidelines suggest a significantly higher dose for secondary prevention due to altered folate metabolism or higher requirements in these individuals. *2 mg* - This dose is also lower than the **established recommendation for high-risk women** who have had a previous NTD-affected pregnancy. - It does not provide the optimal level of protection required to reduce the risk of recurrence effectively.
Question 2: Average extra caloric requirement during second and third trimesters of pregnancy is:
- A. +150 Kcal/day
- B. +350 Kcal/day (Correct Answer)
- C. +520 Kcal/day
- D. +600 Kcal/day
Explanation: ***Correct: +350 Kcal/day*** - The **recommended average extra caloric intake** during pregnancy is approximately **300-350 kcal/day** in the second and third trimesters. - Specifically, **second trimester requires +340 kcal/day** and **third trimester requires +452 kcal/day** (average ~350 kcal/day). - This additional energy is needed to support **fetal growth, placental development, and increased maternal metabolic demands**. - **First trimester** requires minimal increase (0-100 kcal/day). *Incorrect: +150 Kcal/day* - This amount is generally **insufficient** for the increased metabolic demands of the second and third trimesters. - While caloric needs do not significantly increase in the first trimester, they rise substantially in later pregnancy. *Incorrect: +520 Kcal/day* - An extra intake of 520 kcal/day is **higher than the generally recommended** guidelines for most pregnant women. - This level of intake could potentially lead to **excessive gestational weight gain**, increasing risks of gestational diabetes and complications. *Incorrect: +600 Kcal/day* - An additional 600 kcal/day is **significantly above the average recommendation** for caloric intake during pregnancy. - Such high intake is typically **not necessary** and may contribute to **unhealthy weight gain** for both mother and fetus.
Question 3: Dose of vitamin A for an 18 month old baby, with keratomalacia, weighing 10 kg is?
- A. 1,00,000 IU
- B. 50,000 IU
- C. 5,00,000 IU
- D. 2,00,000 IU (Correct Answer)
Explanation: **2,00,000 IU** - For children 12 months of age and older with **keratomalacia** due to vitamin A deficiency, the recommended dose is **200,000 IU** orally, given immediately. - This dose should be repeated the next day and again after four weeks to replenish stores and prevent recurrence. *1,00,000 IU* - This dose is typically recommended for infants **aged 6 to 11 months** with **clinical vitamin A deficiency**, including keratomalacia. - It is insufficient for an 18-month-old child with active keratomalacia. *50,000 IU* - This dose is usually given to infants **under 6 months** of age with clinical signs of **vitamin A deficiency**. - It is too low for an 18-month-old baby with keratomalacia. *5,00,000 IU* - This dose is excessively high and potentially toxic for an 18-month-old child. - Vitamin A toxicity can lead to adverse effects, including **increased intracranial pressure** and liver damage.
Question 4: A 32-year-old female at 36 weeks of pregnancy presents with BP 170/100 mmHg, visual disturbances, headache, urine protein 3+. What will be the next step?
- A. IV labetalol and delivery at 37 weeks
- B. IV labetalol, dexamethasone, and immediate termination of pregnancy
- C. IV labetalol, dexamethasone, and conservative management
- D. IV labetalol, magnesium sulfate (MgSO4), expedite delivery (Correct Answer)
Explanation: ***IV labetalol, magnesium sulfate (MgSO4), expedite delivery*** - The patient presents with **severe preeclampsia** (BP > 160/110 mmHg, visual disturbances, headache, proteinuria) at 36 weeks, requiring **antihypertensive therapy** (labetalol) and seizure prophylaxis (**magnesium sulfate**). - Given the severe features and gestational age, **expedited delivery** is indicated to prevent maternal and fetal complications, as expectant management beyond severe preeclampsia at this stage offers minimal benefit and increased risk. *IV labetalol and delivery at 37 weeks* - While IV labetalol is appropriate for **blood pressure control**, delaying delivery to 37 weeks might not be optimal given the **severe features of preeclampsia** at 36 weeks, increasing risks for both mother and fetus. - The plan is incomplete without mentioning **seizure prophylaxis** with magnesium sulfate, which is crucial for severe preeclampsia. *IV labetalol, dexamethasone, and immediate termination of pregnancy* - **Dexamethasone** is used for **fetal lung maturity** in preterm deliveries and is not indicated for immediate termination unless the fetus is preterm and lung maturity is a concern. At 36 weeks, lung maturity is usually established. - While immediate termination might be considered, the phrase "immediate termination" implies C-section without considering vaginal delivery and overlooks the need for **seizure prophylaxis**. *IV labetalol, dexamethasone, and conservative management* - **Dexamethasone** is not a primary treatment for severe preeclampsia itself but rather for **fetal lung maturation** in preterm deliveries, which is less critical at 36 weeks. - **Conservative management** is generally inappropriate for **severe preeclampsia** at 36 weeks, as it increases maternal and fetal risk; delivery is the definitive treatment.
Question 5: Additional protein and calorie requirements in pregnancy are?
- A. 60 kcal/day calorie, 12 g/day protein
- B. 120 kcal/day calorie, 25 g/day protein
- C. 450 kcal/day calorie, 45 g/day protein
- D. 300 kcal/day calorie, 25 g/day protein (Correct Answer)
Explanation: ***300 kcal/day calorie, 25 g/day protein*** - This option correctly states the typical **additional daily calorie and protein requirements** to support fetal growth and maternal physiological changes during pregnancy, especially during the second and third trimesters. - The **300 kcal/day** accounts for the increased metabolic rate and energy needed for tissue synthesis, while **25 g/day of protein** is crucial for fetal tissue development and maternal blood volume expansion. *60 kcal/day calorie, 12 g/day protein* - These values are **too low** to meet the significantly increased metabolic and growth demands of pregnancy. - Insufficient calorie and protein intake can lead to **poor fetal growth** and adverse pregnancy outcomes. *120 kcal/day calorie, 25 g/day protein* - While the protein requirement of **25 g/day** is appropriate, the **120 kcal/day** increase is still too low to support the full physiological demands of pregnancy. - This would not adequately cover the energy cost of tissue accretion and increased basal metabolic rate. *450 kcal/day calorie, 45 g/day protein* - These values represent an **excessive increase** in both calorie and protein intake for normal pregnancy. - Such high additional intake is generally **not recommended** for the average pregnant woman and could potentially contribute to excessive maternal weight gain or other complications.
Question 6: What is the recommended dietary allowance of iron during pregnancy?
- A. 15 mg of iron
- B. 27 mg of iron (Correct Answer)
- C. 35 mg of iron
- D. 18 mg of iron
Explanation: ***27 mg of iron*** - The **recommended dietary allowance (RDA)** for iron during pregnancy is specifically increased to **27 mg per day** to meet the higher demands of **maternal red blood cell mass expansion** and fetal development. - This increased intake helps prevent **iron-deficiency anemia**, which is common in pregnancy due to the significant increase in **blood volume** and iron transfer to the fetus. *35 mg of iron* - While iron requirements are higher in pregnancy, **35 mg** is generally higher than the widely accepted RDA and might be a dose considered for **iron supplementation** in cases of confirmed deficiency, rather than a general dietary recommendation. - Exceeding the RDA significantly without medical supervision could lead to **iron toxicity** or side effects like constipation and nausea. *15 mg of iron* - **15 mg** is below the recommended daily intake for pregnant women and would be insufficient to meet the increased physiological demands for iron during pregnancy. - This intake level is similar to the RDA for **non-pregnant adult women**, failing to account for the substantial iron needs for **fetal growth and placental development**. *18 mg of iron* - **18 mg** closely matches the RDA for **non-pregnant adult women** and is insufficient for the unique physiological requirements of pregnancy. - This amount would likely lead to a **negative iron balance** and increase the risk of developing **iron-deficiency anemia** as pregnancy progresses.
Question 7: Which of the following statements about folic acid and vitamin B12 is NOT true?
- A. Vegetarians have vitamin B12 deficit
- B. Deficiency of both causes megaloblastic anemia
- C. Recommended daily allowances for Folic acid is 1000 micro grams (Correct Answer)
- D. Both are required for DNA synthesis
Explanation: ***Recommended daily allowances for Folic acid is 1000 micro grams*** - The **recommended daily allowance (RDA)** for folic acid in adults is typically around **400 micrograms (mcg)**, not 1000 mcg. Pregnant women may require a higher intake of 600 mcg. - An intake of 1000 mcg (1 mg) is closer to the **tolerable upper intake level (UL)** for folic acid, above which there is a risk of masking a vitamin B12 deficiency. *Both are required for DNA synthesis* - Both **folic acid** (as tetrahydrofolate) and **vitamin B12** (as methylcobalamin) are essential coenzymes in the **one-carbon metabolism pathway**. - This pathway is crucial for the synthesis of **purines and pyrimidines**, which are the building blocks of **DNA**. *Vegetarians have vitamin B12 deficit* - **Vitamin B12 (cobalamin)** is found almost exclusively in **animal products** (meat, fish, eggs, dairy). - Therefore, individuals following a strict **vegetarian or vegan diet** are at a significant risk of developing a vitamin B12 deficiency if they do not consume fortified foods or supplements. *Deficiency of both causes megaloblastic anemia* - Both **folic acid deficiency** and **vitamin B12 deficiency** impair DNA synthesis, which leads to arrested maturation of red blood cell precursors in the bone marrow. - This results in the production of **large, immature red blood cells** known as **megaloblasts**, clinically manifesting as **megaloblastic anemia**.
Question 8: Which of the following represents the current recommendation for offering screening for Down's syndrome during pregnancy?
- A. 35
- B. No screening necessary
- C. 30
- D. All in the reproductive age group (Correct Answer)
Explanation: ***All in the reproductive age group*** - The American College of Obstetricians and Gynecologists (ACOG) and other major medical bodies recommend that **all pregnant women**, regardless of age, be offered **screening for Down syndrome** and other aneuploidies. - This recommendation reflects the principle of **patient autonomy** and the availability of safe and effective screening methods for all pregnancies, not just those considered high-risk based on maternal age. *30* - While the risk of Down syndrome increases with maternal age, **screening is not exclusively recommended for women aged 30**; rather, it is offered to all pregnant women. - Focusing only on this age group would **miss cases** in younger women and limit informed decision-making. *35* - Historically, **maternal age 35** was considered the threshold for offering invasive diagnostic testing due to the significantly increased risk of Down syndrome. - However, current guidelines emphasize universal screening, as a substantial number of babies with Down syndrome are born to women **younger than 35** due to higher birth rates in this group. *No screening necessary* - This option is incorrect as **screening is routinely offered** to all pregnant women to provide information about the risk of conditions like Down syndrome. - Deciding to forgo screening or diagnostic testing is a personal choice, but the **option to screen should always be available** to the patient.
Question 9: What is the obstetric score of a 26-year-old woman who is 36 weeks pregnant, has had one previous delivery of twins, and is certain of her dates?
- A. G2P1L2 (2 live births) (Correct Answer)
- B. G3P2L2 (3 pregnancies, 2 live births)
- C. G2P2L2 (2 pregnancies, 2 live births)
- D. G3P3L2
Explanation: ***G2P1L2 (2 live births)*** - **Gravida (G)** refers to the total number of pregnancies, including the current one. This woman is currently pregnant and has had one previous pregnancy, making her G2. - **Parity (P)** refers to the number of pregnancies that reached viability (>20 weeks gestation or >500g), *regardless of the number of fetuses*. She had one previous delivery (twins) that reached viability, so her P is 1. The current pregnancy is not included in parity until after delivery. - **Live births (L)** refers to the number of live children delivered. Her previous pregnancy resulted in twins, meaning 2 live births. *G3P2L2 (3 pregnancies, 2 live births)* - This option incorrectly counts the number of pregnancies (**G**) as 3. She has had one previous pregnancy and is currently pregnant, totaling 2 pregnancies. - It also incorrectly counts the parity (**P**) as 2. Parity refers to the number of deliveries that reached viability, not the number of fetuses. Her previous delivery was a single event, making P1. *G2P2L2 (2 pregnancies, 2 live births)* - While the Gravida (G2) and Live births (L2) are correct, the Parity (**P**) is incorrectly stated as 2. Parity refers to the number of viable pregnancies delivered, and she has only had one previous delivery. - The number of fetuses (twins) does not increase the parity count for a single delivery event. *G3P3L2 (3 pregnancies, 3 live births)* - This option incorrectly states the number of pregnancies (**G**) as 3 and the parity (**P**) as 3. - The woman has only had one previous pregnancy and is currently pregnant, for a total of G2 and P1.
Question 10: A pregnant woman comes to the clinic. She has previously delivered twins. What is the correct representation of her obstetric score?
- A. G3P1 (3 pregnancies, 1 delivery)
- B. G2P1 (2 pregnancies, 1 delivery) (Correct Answer)
- C. G3P2 (3 pregnancies, 2 deliveries)
- D. G2P2 (2 pregnancies, 2 deliveries)
Explanation: ***G2P1 (2 pregnancies, 1 delivery)*** - **Gravidity (G)** refers to the total number of times a woman has been pregnant, regardless of outcome. This patient has been pregnant **twice**: once previously (resulting in twins) and once currently. - **Parity (P)** refers to the number of deliveries after 20 weeks gestation. Multiple gestation (twins, triplets) counts as **ONE delivery**, not separate deliveries. Therefore, her previous twin delivery = **P1**. - Current pregnancy status: She is currently pregnant (contributes to gravidity) but has not yet delivered this pregnancy (does not contribute to parity yet). *G3P1 (3 pregnancies, 1 delivery)* - This incorrectly counts the current pregnancy as if she has been pregnant three times total. - The parity is correct (1 delivery), but gravidity is overestimated. *G3P2 (3 pregnancies, 2 deliveries)* - This makes two errors: incorrectly counting three total pregnancies AND incorrectly counting the twin delivery as two separate deliveries. - Remember: multiple gestation = one delivery event, not multiple deliveries. *G2P2 (2 pregnancies, 2 deliveries)* - Gravidity is correct (2 pregnancies total), but this incorrectly counts the twin delivery as two separate deliveries. - Parity should be 1, not 2, because delivering twins is a single delivery event.
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