Which pregnant woman should restrict her weight gain during pregnancy?

Choice A reason: Intranasal spray is not a correct option, as urofollitropin is not available in this form. Intranasal spray is a method of delivering some medications through the nose, where they can be absorbed by the mucous membranes. However, urofollitropin is a protein hormone that would be degraded by the enzymes in the nasal cavity and would not reach the bloodstream effectively.

Choice B reason: Intramuscular injection is the correct option, as urofollitropin is available in this form. Intramuscular injection is a method of delivering medications into the muscle tissue, where they can be absorbed by the blood vessels. Urofollitropin is a protein hormone that needs to be injected into the body to bypass the digestive system and avoid being broken down by the stomach acids and enzymes. Urofollitropin is usually injected into the thigh or buttock muscles once a day for several days, depending on the dosage and the response².

Choice C reason: Vaginal suppository is not a correct option, as urofollitropin is not available in this form. Vaginal suppository is a method of delivering medications into the vagina, where they can be absorbed by the vaginal walls or act locally. Urofollitropin is a protein hormone that would not be absorbed well by the vaginal mucosa and would not reach the ovaries, where it is supposed to stimulate the development of the follicles (eggs).

Choice D reason: Tablet is not a correct option, as urofollitropin is not available in this form. Tablet is a method of delivering medications orally, where they can be swallowed and absorbed by the gastrointestinal tract. Urofollitropin is a protein hormone that would be destroyed by the stomach acids and enzymes and would not reach the bloodstream or the ovaries.

Choice A reason: Diabetes mellitus is not a direct consequence of inadequate weight gain during pregnancy for the infant. However, maternal diabetes can increase the risk of fetal macrosomia (large birth weight), congenital anomalies, and neonatal hypoglycemia (low blood sugar) in the infant.

Choice B reason: Down syndrome is not a direct consequence of inadequate weight gain during pregnancy for the infant. Down syndrome is a genetic disorder caused by an extra copy of chromosome 21 in the cells of the fetus. The risk of having a baby with Down syndrome increases with maternal age, but it is not related to maternal weight or nutrition².

Choice C reason: Spina bifida is not a direct consequence of inadequate weight gain during pregnancy for the infant. Spina bifida is a neural tube defect that occurs when the spine and spinal cord do not form properly in the fetus. The main risk factor for spina bifida is a lack of folic acid (a B vitamin) in the mother's diet before and during pregnancy.

Choice D reason: Intrauterine growth restriction (IUGR) is a condition in which the fetus does not grow as expected and has a low birth weight. IUGR can have many causes, such as placental problems, infections, chromosomal abnormalities, and maternal factors. One of the maternal factors that can contribute to IUGR is inadequate weight gain during pregnancy, especially in underweight women. IUGR can increase the risk of complications for the infant, such as preterm birth, low Apgar score, hypothermia, hypoglycemia, and breathing problems⁵.