The Comprehensive Epilepsy Center has developed guidelines for folate supplementation for women of childbearing years. These guidelines were established to enhance patient education and awareness of the potential vitamin deficiencies that can occur when taking antiepilepsy medications (AED's). They help to promote the general health of women, and minimize potential birth defects associated with folate deficiency.
Folate (or folic acid) deficiency and medications used to treat epilepsy are associated with an increased risk of birth defects. Specifically, they are associated with spina bifida and anencephaly, two of the most common and severe neurologic birth defects. Clinical studies have shown that supplementing a woman's diet with folate can reduce this risk by 50-75%.
In order to reduce the risk of neural tube defects, the Center for Disease Control and Prevention (CDC) recommends that all women who are capable of becoming pregnant should take 0.4 mg of folate each day. Neural tube defects occur early in the pregnancy, often before a woman is aware that she is pregnant. In additional, about one-half of pregnancies in the United States are unplanned. Therefore, supplementation with folate should continue throughout a woman's reproductive years. A woman who has a family history of neural tube defects or has a previous child born with neural tube defects should receive folate supplementation of 4.0 mg per day.
The Comprehensive Epilepsy Center Guidelines for Folate supplementation are as follows
All women should supplement their diet by taking 1 prenatal multivitamin each day. Prenatal multivitamins are available over-the-counter (OTC) or by prescription. OTC prenatal multivitamins contain 0.8 mg of folate while prescription prenatal multivitamins contain 1.0 mg of folate. Generic multivitamins are generally the least expensive, followed in order of expense by brand name over-the-counter vitamins, and finally prescription tablets.
A woman who is planning on becoming pregnant or who is pregnant, and has a family history of neural tube defects, or has had a previous child born with neural tube defects, or is on either Tegretol or Depakote, should receive 3.0 mg of folate in addition to a prenatal multivitamin.
All other women who are planning to become pregnant or are pregnant and taking an antiepilepsy medication other than Tegretol or Depakote should receive 1.0 mg of folate in addition to a prenatal multivitamin.
Editorials, Urgent Need to Increase Folic Acid Consumption, JAMA. December 6, 1995. Volume 274, No. 21.
Delgado-Escueta, A.V., and D. Janz. Consensus Guidelines: Preconception counseling, management, and care of the pregnant woman with epilepsy. Neurology, 1992. 42(suppl 5); 149-160.
Daly, L.E., et al. Folate levels and neural tube defects: implications for prevention. JAMA. 1995; 274: 1698-1702.
Morrell, M.J. The New Antiepileptic Drugs and Women: Efficacy, Reproductive Health, Pregnancy, and Fetal Outcome. Epilepsia. 1996. 37 (suppl. 6); S34-S44.