Carol is a 34-year-old woman who was pregnant recently for the first time, but the baby had anencephaly and died at birth. She has a sister who has spina bifida and an older brother who had a stroke...

Carol is a 34-year-old woman who was pregnant recently for the first time, but the baby had anencephaly and died at birth. She has a sister who has spina bifida and an older brother who had a stroke when he was 14. Carol has now been tested and found to have a genetic defect known as a 677C.T polymorphism in the methylenetetrahydrofolate reductase (MTHFR) gene. Of course, she and her husband were devastated with the loss of their first child, but they also very much want to be parents. She has gone to genetic counseling but is also coming to you to find out what she can do to lower the chances that this happens again. She is worried about using the traditional prenatal vitamin-mineral supplement because she has been cautioned that she is unable to metabolize folic acid from diet and supplements.

Nutrition Diagnostic Statement

 Altered nutrient (folic acid) metabolism related to a genetic alteration as evidenced by positive results for C.T in the MTHFR gene and family history of spina bifida and stroke

Nutrition Care Questions

1. What advice would you give Carol about any special dietary changes?

2. Carol knows that there is a special prenatal vitamin-mineral supplement available but does not know how to obtain it. How will you help Carol find this supplement?

 3. What are the risks for a successful pregnancy outcome if Carol cannot find this special prenatal supplement?

4. What other concerns do you have regarding her pregnancy?