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Modeling predicted that incorporating weight would increase the detection rate compared with BPD and AFP alone by 3% and BMI would increase it by 4%. Incorporating maternal weight into first trimester spina bifida screening protocols will increase detection. Incorporating maternal weight into first trimester spina bifida screening protocols will increase detection. Language proficiency plays an important role in healthcare choices and access. Differences in access to biologic medications exist, but it is unknown how much English profici