From the Guidelines
Pregnant patients with epilepsy require higher doses of folic acid, specifically 4 mg daily, to reduce the risk of neural tube defects and other congenital malformations. This recommendation is based on the evidence that antiepileptic medications can interfere with folate metabolism or absorption, potentially increasing the risk of birth defects 1. The American Family Physician recommends that women with seizure disorders take 4 mg of folic acid daily, starting at least one month before conception and continuing through the first trimester 1. Key points to consider include:
- The risk of neural tube defects is higher in women with epilepsy, particularly those taking antiepileptic medications 1
- Folic acid supplementation can reduce the risk of neural tube defects, and higher doses may be necessary for women with epilepsy 1
- Women with epilepsy should discuss folic acid supplementation with their neurologist and obstetrician to determine the best course of treatment for their individual needs. It's essential to continue taking prescribed antiepileptic medications during pregnancy as directed by a neurologist, as uncontrolled seizures pose significant risks to both mother and baby. The most recent and highest quality study supports the recommendation of 4 mg of folic acid daily for pregnant patients with epilepsy 1.
From the FDA Drug Label
Folic acid requirements are markedly increased during pregnancy, and deficiency will result in fetal damage The answer is yes, pregnant patients with epilepsy may require more folic acid, as folic acid requirements are markedly increased during pregnancy.
- Key points:
- Folic acid requirements are increased during pregnancy
- Deficiency can result in fetal damage
- Folic acid should be used during pregnancy only if clearly needed 2
From the Research
Folic Acid Supplementation in Pregnant Patients with Epilepsy
- The current recommendation is that all women of childbearing potential, including those with epilepsy, be supplemented with at least 0.4 mg of folic acid daily prior to conception and during pregnancy 3.
- However, some studies suggest that the standard periconceptual use of 400 μg of folic acid may not adequately protect against valproate or other antiepileptic drug (AED)-induced congenital or developmental risks 4.
- It is proposed that up to 5 mg of folic acid periconceptually may be necessary in at-risk women, although more research is needed to determine the appropriate dose 4.
- Women with epilepsy have a higher risk of bearing children with congenital malformations, and folic acid supplementation is recommended to reduce this risk, although its efficacy in this population is unclear 5, 6.
- Despite the uncertainty, folic acid supplementation is still recommended for women with epilepsy at dosage levels similar to those for the general population of women of childbearing age 5, 6.
Factors Influencing Folic Acid Supplementation
- The type and number of antiepileptic drugs (AEDs) do not appear to affect folic acid supplementation rates in women with epilepsy 7.
- Age may be a factor, with women aged 40 or younger more likely to receive folic acid supplementation than those over 40 7.
- Patient and physician-targeted interventions may be necessary to increase folic acid prescription and patient adherence 7.