A 30-Year-Old Woman, Gravida 2 Para 1 Aborta 1, Comes

A 30-year-old woman, gravida 2 para 1 aborta 1, comes to the office for preconception counseling.  The patient's first pregnancy 10 years ago ended in a term cesarean delivery due to fetal malpresentation.  That pregnancy was otherwise uncomplicated.  She is now with a new partner and recently had a first-trimester spontaneous abortion.  The patient has no chronic medical conditions and has had no surgeries other than the cesarean delivery.  She has no history of sexually transmitted infections.  Her last Pap test, 2 years ago, was normal.  She takes a prenatal vitamin daily.  The patient does not use cigarettes or illicit drugs but drinks a glass of wine on the weekend.  She drinks 3 cups of coffee each morning.  The patient participates in a 30-minute aerobics class 3 times a week and plays tennis every weekend.  Blood pressure is 110/60 mm Hg and pulse is 68/min.  BMI is 22 kg/m².  Physical examination reveals a small, nontender, retroverted uterus; no adnexal masses or tenderness; and a cervix with no visible lesions or discharge.  The patient wants to know what she can do to prepare for her next pregnancy.  Which of the following is the most appropriate response regarding this patient's risk for another spontaneous abortion?

A) Decreasing caffeine intake decreases the risk of spontaneous abortion.
B) Decreasing the amount of exercise decreases the risk of spontaneous abortion.
C) Karyotype analysis is indicated to determine the risk of spontaneous abortion.
D) The patient is at increased risk for spontaneous abortion due to her history of spontaneous abortion.
E) The previous cesarean delivery increases the risk of spontaneous abortion.