From the Guidelines
For women with epilepsy who are pregnant or planning pregnancy, the recommended folic acid dose is 4 to 5 mg daily. This higher dose is necessary due to the potential interference of antiepileptic drugs with folate metabolism or absorption, which can increase the risk of neural tube defects in the developing fetus 1. The increased dosage should be started at least three months before conception and continued until 12 weeks postconception, as recommended by the American Family Physician study published in 2013 1. Some key points to consider include:
- Women with epilepsy should take the higher dose of 4 to 5 mg of folic acid daily due to their increased risk of neural tube defects 1
- The higher dose of folic acid helps counteract the effect of certain antiepileptic drugs that can deplete folate levels in the body
- It is essential to take the folic acid supplement separately from antiepileptic drugs, preferably at different times of the day, to maximize absorption
- While high-dose folic acid supplementation is recommended, it does not completely eliminate the increased risk of birth defects associated with some antiepileptic drugs, particularly valproate, which should be avoided during pregnancy if possible. Key considerations for folic acid supplementation in women with epilepsy include:
- Starting the higher dose of 4 to 5 mg at least three months before conception
- Continuing the higher dose until 12 weeks postconception
- Taking the folic acid supplement separately from antiepileptic drugs to maximize absorption.
From the FDA Drug Label
When clinical symptoms have subsided and the blood picture has become normal, a daily maintenance level should be used, i.e., ... 0.8 mg for pregnant and lactating women, but never less than 0. 1 mg/day. In the presence of ... anticonvulsant therapy, the maintenance level may need to be increased. The recommended folic acid dose for epilepsy in pregnancy is 0.8 mg or more, as the maintenance level may need to be increased in the presence of anticonvulsant therapy 2.
- The dose may be adjusted based on the patient's response and the presence of other conditions.
- The maximum dose is not explicitly stated for pregnant women with epilepsy, but daily doses greater than 1 mg do not enhance the hematologic effect.
From the Research
Folic Acid Dosage for Epilepsy in Pregnancy
- The recommended folic acid dose for women with epilepsy is at least 0.4 mg daily prior to conception and during pregnancy 3.
- However, some studies suggest that a higher dose of 5 mg/day may be administered 3 months before conception and during the first trimester to prevent folic acid deficiency-induced malformations 4.
- It is essential to note that high doses of folic acid may interact with some anti-epileptic drugs (AEDs) and have adverse effects on fetal brain development, so the optimal dosing is still a topic of debate 3.
- Periconceptional folic acid supplementation has been associated with a lower risk of preterm birth in women with epilepsy using antiseizure medication (ASM) 5.
Key Considerations
- Women with epilepsy should be counseled to take folic acid during pregnancy to reduce the risks of cardiovascular, genitourinary, and neural tube defects 6.
- The selection of AEDs is crucial in women with epilepsy, and those with the lowest malformation rates should be used during pregnancy 6.
- Folic acid supplementation rate is low in nonpregnant women of childbearing age with epilepsy, and patient and physician-targeted interventions should be implemented to increase FA prescription and patient adherence 7.