Abstract
Abstract
Background
Although some antiseizure medications (ASMs) are teratogenic, most people with epilepsy need treatment in pregnancy. The risk of ASM fetotoxicity may be mitigated with folic acid. High-dose folic acid supplementation has traditionally been recommended before and during gestation despite little evidence of efficacy and safety for this patient group. Several studies have investigated the potential benefits and risks of folic acid supplements.
Objective
To provide an updated overview of the risks, benefits, and rationale for use of folic acid supplementation in relation to pregnant people of childbearing age using ASM.
Materials and methods
This is a narrative review based on an unstructured literature search of PubMed. We also scrutinized neurological and obstetrical guidelines.
Results
Antiseizure medication can decrease folate concentrations. In children exposed to ASM prenatally, those born to persons using folic acid supplements periconceptionally had lower risk of adverse neurodevelopment and preterm birth. It remains unclear whether the risk for congenital malformations can be equally alleviated. In studies of the general population, high plasma folate concentrations and/or high-dose folic acid supplements were associated with adverse neurodevelopmental outcomes. This has not been seen in children of mothers with epilepsy. However, an increased cancer risk has been found in children of mothers with epilepsy using high-dose folic acid supplements in pregnancy.
Conclusion
The optimal folic acid dose is not clear for persons of childbearing potential with epilepsy using ASM. Both low and excess folate status during pregnancy have been associated with adverse neurodevelopment. We propose an individual folic acid supplement dose that should be titrated based on maternal plasma folate concentrations during pregnancy.
Publisher
Springer Science and Business Media LLC
Reference70 articles.
1. Gerard EE, Meador KJ (2016) Managing epilepsy in women. Continuum (Minneap Minn) 22:204–226
2. Dwyer ER, Filion KB, MacFarlane AJ, Platt RW, Mehrabadi A (2022) Who should consume high-dose folic acid supplements before and during early pregnancy for the prevention of neural tube defects? BMJ 377:e67728
3. McNulty H, Ward M, Hoey L, Hughes CF, Pentieva K (2019) Addressing optimal folate and related B‑vitamin status through the lifecycle: health impacts and challenges. Proc Nutr Soc 78(3):449–462. https://doi.org/10.1017/S0029665119000661
4. Husebye ESN, Riedel B, Bjorke-Monsen AL et al (2021) Vitamin B status and association with antiseizure medication in pregnant women with epilepsy. Epilepsia 62(12):2968–2980. https://doi.org/10.1111/epi.17076
5. SIGN Diagnosis and management of epilepsy in adults: a national clinical guideline. https://www.sign.ac.uk/media/1079/sign143_2018.pdf. Accessed 03.01.
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