A routine prenatal ultrasound reveals a male fetus with meningomyelocele. The 24-year-old primigravid mother is told the infant will require surgery shortly after birth. You counsel her about the etiology of this defect and the risk of further pregnancies being similarly affected, and state which of the following?

**Core Concept**
Meningomyelocele is a type of congenital anomaly resulting from the incomplete closure of the neural tube during embryonic development. This defect leads to the protrusion of the meninges and spinal cord through a defect in the vertebral column. The etiology of meningomyelocele involves genetic and environmental factors.

**Why the Correct Answer is Right**
Meningomyelocele is associated with an increased risk of recurrence in subsequent pregnancies, particularly in families with a history of neural tube defects. This risk is due to the presence of genetic mutations affecting folate metabolism, such as the MTHFR gene. The mother's age and primigravid status do not significantly contribute to the risk of recurrence. However, the MTHFR gene mutation can be inherited from either parent, and the risk of recurrence is higher if both parents are carriers of the mutation.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because the mother's age and primigravid status do not significantly contribute to the risk of recurrence of meningomyelocele.
**Option B:** This option is incorrect because the father's age and genetic factors do not play a significant role in the etiology of meningomyelocele.
**Option C:** This option is incorrect because the risk of recurrence is not solely determined by the mother's diet or lifestyle factors.

**Clinical Pearl / High-Yield Fact**
Meningomyelocele is a neural tube defect that can be prevented or reduced in incidence with folic acid supplementation before and during pregnancy, particularly in women with a history of neural tube defects or those at high risk of recurrence.

**Correct Answer:** D.

✓ Correct Answer: D. Supplementation of maternal diet with folate leads to a decrease in incidence of this condition.