Which factors are associated with an increased risk for spina bifida?

• A. All of the above
• B. Only race
• C. Only socioeconomic status
• D. Only anticonvulsants

Answer: (A)

Spina bifida risk is influenced by multiple maternal factors, and these factors can accumulate to increase the likelihood of the condition. Anticonvulsant exposure during pregnancy, especially valproic acid, is a well-established teratogen linked to higher rates of neural tube defects. Socioeconomic status affects risk indirectly through access to folic acid supplementation and quality prenatal care; limited resources can mean less folate intake and fewer preventive services. Race or ethnicity is also associated with different baseline risks for neural tube defects, reflecting genetic and environmental interactions.

Because each of these factors has a credible association with increased risk, recognizing that multiple influences can be present provides the most complete understanding. In practice, this means emphasizing folic acid supplementation before conception and in early pregnancy, carefully considering anticonvulsant therapy with guidance from a clinician, and offering targeted support to populations with higher baseline risk.