A nurse is screening a client at 16 weeks of gestation. Which of the following factors in the client's health history should the nurse identify as raising the risk for a myelomeningocele? (Select All that Apply.)

A. This is protective, not a risk factor. Adequate folic acid intake (usually 400–800 mcg daily) before conception and during the first trimester significantly reduces the risk of neural tube defects, including myelomeningocele. Supplementation helps ensure proper closure of the neural tube, which normally occurs by the 28th day of gestation. Therefore, a client taking folic acid as recommended is actually lowering her risk. B. Exposure to ionizing radiation, especially during the first trimester, is a known teratogenic factor that can interfere with neural tube development. Radiation can damage rapidly dividing cells and disrupt embryonic development, increasing the likelihood of congenital anomalies such as myelomeningocele. Occupations involving X-rays, radioactive materials, or high-energy radiation require careful protective measures for pregnant employees. C. A personal history of neural tube defects in a previous pregnancy is a strong risk factor for recurrence. This is due to genetic susceptibility and possibly environmental factors that influenced the first pregnancy. Women with a history of a child with a neural tube defect are often advised to take a higher dose of folic acid (4 mg daily) before conception and during early pregnancy to help prevent recurrence. D. Alcohol consumption during pregnancy can cause fetal alcohol spectrum disorders, which include growth restriction, facial abnormalities, and neurodevelopmental deficits. However, alcohol is not directly linked to neural tube defects such as myelomeningocele. While it is harmful overall to fetal development, it does not specifically increase this risk. E. Having a relative with epilepsy is not a direct risk factor for myelomeningocele. The risk only increases if the mother herself requires anti-epileptic medications during pregnancy, particularly drugs like valproic acid, which are teratogenic and associated with neural tube defects. A family history without maternal medication use does not independently raise risk.