What is the role of folic acid supplementation in the treatment of pregnant women with epilepsy?

Updated: Aug 20, 2019
  • Author: Carmel Armon, MD, MSc, MHS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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The AAN/AES guidelines state that preconception folic acid supplementation is possibly effective in preventing major congenital malformations in the newborns of women with epilepsy taking antiepileptic drugs (AEDs).This is a Centers for Disease Control and Prevention (CDC) recommendation for all women of childbearing potential. The optimal dose for women with epilepsy has not been determined, and the guidelines suggest that giving these women at least 0.4 mg/day of folic acid before they become pregnant may be considered.

The authors’ practice is to provide folic acid supplementation at a dosage of 4 mg/day to women taking AEDs who are planning to become pregnant. One report found that folic acid supplementation was associated with a significant reduction in spontaneous abortion. [21] Among women on monotherapy, this effect was evident for those taking valproate but not those taking carbamazepine, phenytoin, or phenobarbital, possibly as a result of the reduced baseline teratogenicity of the last 3 drugs relative to that of valproate.

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