Review Practice Exercise 1

Maternal Risk Factors > Maternal Newborn

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Practice Exercise 1

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Total Questions : 4

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Question 1:

A 16-year-old primigravida presents for her first prenatal visit. Which of the following risks is specifically heightened due to her adolescent age?

A. Increased likelihood of gestational diabetes mellitus. B. Higher incidence of chromosomal abnormalities. C. Elevated risk of cephalopelvic disproportion (CPD). D. Greater chance of placenta previa.

Answer and Explanation

Choice A:

Gestational diabetes mellitus occurs more frequently in women >25 years, especially with obesity or family history. Adolescents generally have higher insulin sensitivity, and the pathophysiology does not favor increased risk in this group.

Choice B:

Chromosomal abnormalities, such as trisomy 21, are linked to advanced maternal age because of meiotic nondisjunction. The risk at age 16 is extremely low compared to women >35 years.

Choice C:

Cephalopelvic disproportion is more likely in adolescents due to incomplete pelvic maturation. A smaller bony pelvis increases the chance of obstructed labor. The question stem highlights her young age (16 years), which is the main factor raising the risk for CPD.

Choice D:

Placenta previa incidence increases with maternal age, multiparity, and uterine scarring from surgeries. A primigravida adolescent without prior uterine surgery has no significant predisposition to placenta previa.

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Question 2:

Which of the following maternal age groups is associated with an increased risk of chromosomal abnormalities such as Down syndrome?

A. 18–24 years B. 25–30 years C. 31–34 years D. 35 years and older

Answer and Explanation

Choice A:

The age group 18–24 years carries a very low risk for chromosomal abnormalities, with Down syndrome occurring in about 1 in 1,400 live births at age 20. Nondisjunction errors are uncommon in this group.

Choice B:

Women aged 25–30 years have only a slightly increased risk compared to teenagers, with trisomy 21 risk around 1 in 1,000. This is not considered a high-risk age group.

Choice C:

Ages 31–34 years show a gradual increase in risk, with trisomy 21 risk at age 32 being about 1 in 900. However, this group is not defined as high risk until ≥35 years.

Choice D:

Maternal age ≥35 years is strongly associated with chromosomal nondisjunction events during oogenesis. This significantly increases the risk of Down syndrome and other trisomies. The question directly asks for the age group linked to increased chromosomal abnormality risk, making this option correct.

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Question 3:

Which of the following are risks associated with adolescent pregnancy? Select all that apply.

A. Increased risk of preterm birth B. Decreased risk of preeclampsia C. Higher incidence of low birth weight D. Reduced likelihood of cesarean delivery E. Elevated risk of intimate partner violence

Answer and Explanation

Choice A:

Preterm birth is more common in adolescents because of biologic immaturity and inadequate cervical competence, as well as poor access to prenatal care. This raises risk for neonatal morbidity and mortality.

Choice B:

The risk of preeclampsia is not decreased in adolescents; in fact, it may be increased, especially in first pregnancies due to immunologic factors. A blood pressure ≥140/90 mmHg is diagnostic for hypertensive disorders in pregnancy.

Choice C:

Low birth weight is frequent due to maternal malnutrition, iron deficiency, and increased risk of intrauterine growth restriction. Infants <2,500 g are more likely in adolescent pregnancies.

Choice D:

Adolescents do not have reduced likelihood of cesarean delivery. In fact, rates may be higher due to cephalopelvic disproportion from incomplete pelvic growth, leading to obstructed labor.

Choice E:

Intimate partner violence risk is elevated in adolescents, related to power imbalances, dependency, and limited social support. This contributes to adverse maternal and fetal outcomes.Rationale for incorrect answers

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Question 4:

Which of the following are complications associated with advanced maternal age? Select all that apply.

A. Increased risk of gestational diabetes mellitus B. Higher likelihood of Down syndrome C. Reduced risk of stillbirth D. Increased incidence of placenta previa E. Lower rates of preterm birth

Answer and Explanation

Choice A:

Gestational diabetes mellitus risk increases with maternal age due to reduced insulin sensitivity and higher rates of obesity. This is strongly associated with advanced maternal age.

Choice B:

Down syndrome risk increases sharply after 35 years because of meiotic nondisjunction. Oocyte aging leads to chromosomal errors.

Choice C:

Stillbirth risk is not reduced with age. In fact, women ≥35 years have higher rates of stillbirth, likely related to placental insufficiency and medical comorbidities.

Choice D:

Placenta previa is more frequent in women ≥35 years due to endometrial scarring and impaired placental implantation. Advanced maternal age is a recognized risk factor.

Choice E:

Preterm birth is not lower in advanced maternal age. The risk is increased, partly due to obstetric complications such as hypertension, diabetes, and placenta previa.

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Total Questions : 4

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Practice Exercise 1

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