# Situation: A 22-year-old primigravida registers at the Rural Health Unit (RHU) at 12 weeks' gestation. Before pregnancy she weighed 42 kg, and her height is 152 cm. She has no medical conditions and a single fetus. The nurse starts her on iron–folic acid supplementation under the Department of Health (DOH) program for pregnant women. Which regimen of elemental iron and folic acid does the program provide?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629567  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A 22-year-old primigravida registers at the Rural Health Unit (RHU) at 12 weeks' gestation. Before pregnancy she weighed 42 kg, and her height is 152 cm. She has no medical conditions and a single fetus.

The nurse starts her on iron–folic acid supplementation under the Department of Health (DOH) program for pregnant women. Which regimen of elemental iron and folic acid does the program provide?

## 보기

1. 30 mg iron and 400 mcg folic acid daily from 20 weeks until delivery
2. 60 mg iron and 400 mcg folic acid daily for about 180 days **✔ 정답**
3. 27 mg iron and 4 mg folic acid daily throughout pregnancy
4. 60 mg iron and 2.8 mg folic acid once a week for 3 months

**정답: 2**

## 해설

The DOH gives pregnant women 60 mg elemental iron plus 400 mcg folic acid daily, about 180 tablets across pregnancy, starting at the first prenatal visit. Weekly iron with 2.8 mg folic acid is the intermittent regimen for nonpregnant women of reproductive age, 4 mg folic acid is the prescribed dose after a previous neural tube defect, and 27 mg is the U.S. daily iron allowance.

## 심화 해설

The DOH regimen for pregnant women
The Department of Health (DOH) program for pregnant women provides 60 mg elemental iron plus 400 mcg folic acid daily, for a total of about 180 tablets across the pregnancy. Supplementation starts at the first prenatal visit, not at a fixed week of gestation. This primigravida registered at 12 weeks, so she starts the daily tablet now and continues it through pregnancy. The program regimen is 60 mg iron and 400 mcg folic acid daily for about 180 days.

Why both nutrients are given
Iron needs rise sharply in pregnancy because of the expanding maternal red cell mass, the growing fetus and placenta, and the blood lost at birth. Iron deficiency anemia in pregnancy is linked to fatigue, preterm birth, and low birth weight, and it reduces the mother's reserve against postpartum hemorrhage. Folic acid supports rapid cell division and helps prevent neural tube defects, although its protective effect on the neural tube is greatest around conception and early pregnancy. Her low prepregnancy weight of 42 kg at 152 cm also places her at nutritional risk, making supplementation and dietary counseling important.

Recognizing the distractor regimens
Each wrong option is a real regimen used for another purpose.

| Regimen | Where it belongs |
| --- | --- |
| 60 mg iron + 400 mcg folic acid daily, about 180 days | DOH regimen for pregnant women |
| 60 mg iron + 2.8 mg folic acid once a week for 3 months | Intermittent regimen for nonpregnant women of reproductive age |
| 4 mg folic acid daily | Prescribed high dose for women with a previous neural tube defect |
| 27 mg iron daily | U.S. recommended daily iron intake in pregnancy |
| 30 mg iron from 20 weeks | Starts too late; not the program dose |

Watch out! The 30 mg option combines two errors: it starts at 20 weeks instead of the first prenatal visit, and it uses a lower dose than the program provides. Starting at the first visit gives the mother the full benefit of supplementation throughout pregnancy.

Counseling for adherence
The nurse explains that the tablet may cause dark stools, nausea, or constipation, and that taking it with meals or at bedtime can reduce stomach upset. Taking it with vitamin C-rich foods improves absorption, while tea, coffee, and milk taken at the same time reduce it. The nurse records the tablets given at each visit and checks adherence, since the benefit depends on completing about 180 tablets.

Exam takeaway
DOH pregnancy supplementation: 60 mg elemental iron plus 400 mcg folic acid daily from the first prenatal visit, about 180 tablets. Key point! Weekly 2.8 mg folic acid is for nonpregnant women, and 4 mg folic acid is for a previous neural tube defect.

## 임상 시나리오

Iron-Folic Acid in PregnancyDOH program regimen at the first prenatal visit
Give 60 mg elemental iron plus 400 mcg folic acid daily, about 180 tablets across pregnancy.

Start at the first prenatal visit, not at a set week of gestation.

Teach about dark stools and stomach upset, take with vitamin C-rich foods, and avoid tea, coffee, or milk at the same time.

CautionDo not confuse this with the weekly 2.8 mg folic acid regimen for nonpregnant women or the 4 mg dose for a previous neural tube defect.

## 핵심 개념

- **Elemental iron** — The amount of actual iron in an iron salt tablet, used to express the supplement dose.
- **Folic acid** — A B vitamin needed for cell division that helps prevent neural tube defects.
- **Neural tube defect** — A birth defect of the brain or spinal cord, such as spina bifida, from incomplete closure of the neural tube.
- **Iron deficiency anemia** — Low hemoglobin due to lack of iron, common in pregnancy and linked to poor outcomes.

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