Pregnant and Epileptic? Consider Folic Acid

Folic acid and pregnancyOne of the standard (and heavily simplified) pieces of advice given to women during pregnancy is to avoid actions that could harm the growing fetus within them. Unfortunately, there are times when the safety of the mother means the infant could be placed at risk. Drugs meant to treat epilepsy, for instance, are known to raise the risk of neural tube defects, heart defects, diminished IQ, or even autism depending on the exact drug in question.

However, simply stopping the drugs during pregnancy is not always a viable option since it is generally a bad idea to let a pregnant woman (or anyone else) have a seizure. Therefore, there is a lot of interest in finding ways to reduce developmental risks to the fetus without risking the mother’s health. An interesting study out of Norway has suggested one possible avenue in the form of folic acid supplementation.

The Nordic Study on Folic Acid and Pregnancy: Summary

  • The study’s abstract was presented at the Second Congress of the European Academy of Neurology and has yet to be published in a journal
  • The study looked at 58,000 three-year-olds whose mothers were either healthy or epileptic and were assessed for autistic traits
  • Mothers were also grouped based on whether they took epilepsy drugs during pregnancy and their possible folic acid intake was noted
  • Folic acid concentration in the blood was also looked at for those who took epilepsy drugs during pregnancy
  • 12% of children whose mothers took epilepsy drugs showed autistic traits
  • 3% of children whose mothers were epileptic but did not take epilepsy drugs showed autistic traits
  • 4% of children whose mothers were otherwise healthy showed autistic traits
  • Among the women who took epilepsy drugs, the effect on autistic traits was more noticeable if they stopped folic acid supplements early in the pregnancy. It was about six times higher than among the women who took both epilepsy drugs and folic acid supplements
  • This association was supported by the folic acid concentration in the blood, which was lower among the worse outcomes

What This Means

The risks of epilepsy medication while pregnant have been known for some time, so the point to focus on here is the idea that folic acid supplementation can mitigate the risk and, if the results are to be taken at face value, even bring it in line with the normal population. Speaking generally, this use of folic acid does have plausibility behind it. Folic acid helps prevent neural tube defects. Neural tube defects are among the possible side effects of taking certain epilepsy medications while pregnant. Therefore it is not unreasonable to suspect there might be some way for folic acid to mitigate other side effects of something capable of causing neural tube defects since the two clearly overlap in which parts of the body they affect. This is an extremely summarized explanation but the takeaway is that prior plausibility means the results are less likely to be flukes.

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Having said that, there is one distinct weakness to the study. As mentioned in the summary, the researchers were calculating “possible” folic acid supplementation during pregnancies that had been over for three years. While there are various research and analytical tools that could be used to fill in the gaps, the fact that estimation was involved does make the associations less solid than would be preferred. This does not mean the findings aren’t valid, just that it was a limitation of the study.

There are also a few points where more information would have been appreciated, though it is possible they will be covered in the full study when it is eventually published:

  • Which specific epilepsy drugs were the mothers on? Different drugs have different levels of side effect risks
  • Actual numbers behind the percentages would have been appreciated since it isn’t clear how many mother/child pairs fell into each group

Lastly, it’s important to keep in mind that “autism traits” is different from “autism diagnoses”. While there is undoubtedly overlap between the two, the distinction matters when trying to put this study in context.

Bottom Line

  • Folic acid supplementation is important during pregnancy to reduce the risk of certain birth defects. If the mother is on epileptic medication, the importance of folic acid may be higher than normal

Sources for Today’s Article:

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“Use of Sodium Valproate in Pregnancy,” MedSafe web site, December, 2014; http://www.medsafe.govt.nz/profs/PUArticles/December2014SodiumValproate.htm, last accessed June 1, 2016.

“Antiepileptic drugs during pregnancy: folic acid could help to prevent autism,” AlphaGalileo web site, http://www.alphagalileo.org/ViewItem.aspx?ItemId=164673&CultureCode=en, last accessed June 1, 2016.