A 35-year-old woman, gravida 2 para 1, arrives at the office for a prenatal exam. The patient claims she had been using condoms for birth control and had became pregnant inadvertently. Her last period was two months ago, and home pregnancy tests came back positive. She did not take prenatal vitamins. The patient has a 5-year-old daughter who was born following a smooth pregnancy. She has a history of rheumatoid arthritis, and methotrexate treatment helps her joint discomfort. There are no additional medical issues or drugs that the patient is taking. She does not smoke, drink, or use illegal drugs. Vital signs are normal, and a physical examination reveals no abnormalities. Serum Beta-hCG is elevated, and transvaginal ultrasonography shows a normal gestational sac and embryo. This patient's unborn child is at the greatest risk for which of the following congenital defects?

Question

A 35-year-old woman, gravida 2 para 1, arrives at the office for a prenatal exam. The patient claims she had been using condoms for birth control and had became pregnant inadvertently. Her last period was two months ago, and home pregnancy tests came back positive. She did not take prenatal vitamins. The patient has a 5-year-old daughter who was born following a smooth pregnancy. She has a history of rheumatoid arthritis, and methotrexate treatment helps her joint discomfort. There are no additional medical issues or drugs that the patient is taking. She does not smoke, drink, or use illegal drugs. Vital signs are normal, and a physical examination reveals no abnormalities. Serum Beta-hCG is elevated, and transvaginal ultrasonography shows a normal gestational sac and embryo.  This patient's unborn child is at the greatest risk for which of the following congenital defects?

Quizplus · Accepted Answer

Eductional Objective: Methotrexate and other folic acid antagonists have a negative effect on rapidly proliferating cells (e.g., epithelial cells, stem cells, neural tube cells) by restricting the creation of DNA synthesis and repair precursors. These medicines can cause significant congenital malformations if taken during the first trimester of pregnancy (eg, cardiovascular abnormalities, neural tube defects).

A 35-Year-Old Woman, Gravida 2 Para 1, Arrives at the Office