A 24-year-old primigravida at 14 weeks of gestation undergoes routine obstetric ultrasound. The structure marked **A** in the diagram shows absent cranial vault above the orbits with exposed brain tissue floating in amniotic fluid. The patient reports irregular dietary intake and denies folic acid supplementation before conception. Which of the following is the most important modifiable risk factor that likely contributed to this neural tube defect?
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