A 32-year-old woman, gravida 1, para 0, aborta 1, and her partner present to the...

This patient had a single spontaneous abortion and is planning another pregnancy. MCCQE objectives emphasize modifiable risk factor reduction and evidence-based preconception counseling. Smoking is a well-established risk factor for miscarriage, placental complications, fetal growth restriction, and preterm birth. Therefore, smoking cessation is the most effective intervention among the options listed to improve the likelihood of a healthy term pregnancy.

A 2-cm subserosal fibroid does not distort the uterine cavity and is unlikely to contribute to miscarriage; surgical removal is not indicated. There is no evidence that abstaining from intercourse in the first trimester prevents miscarriage. After a single early pregnancy loss, there is no need to delay conception for 6 months; couples may attempt pregnancy once emotionally and physically ready.

While folic acid supplementation is recommended preconceptionally, the standard dose for low-risk women is 0.4–1 mg daily, not 5 mg (which is reserved for high-risk patients). Thus, smoking cessation is the most important advice.