Folic Acid Supplements in Pregnancy Help Kids of Women With Epilepsy

Drugs taken in pregnancy to prevent epilepsy seizures can raise the risk of language delays in children. But new research shows that folic acid supplements can cut that risk.

One U.S. ob/gyn said the finding has real importance for his younger female patients.

"The risk of language delay was decreased by half -- the benefit of folic acid in this situation is striking," said Dr. Mitchell Kramer, who wasn't involved in the new study.

"It's important to advise pregnant women to take folic acid supplementation in their diets in general, but it is especially important in women being treated for epilepsy," said Kramer, who directs obstetrics and gynecology at Huntington Hospital, in Huntington, N.Y.

The new Norwegian trial included 335 children of mothers with epilepsy who took epilepsy drugs while they were pregnant, and more than 104,000 children of mothers without epilepsy.

Continuing epilepsy treatment during pregnancy is important because seizures could harm the fetus and mother, said the research team led by Dr. Elisabeth Synnove Nilsen Husebye, of the University of Bergen.

Among children whose mothers did not take folic acid before and early in pregnancy, delays in language skills at 18 months of age were observed in 34 percent of children whose mothers had epilepsy, the study found. That's compared to just 11 percent for children whose mothers didn't have epilepsy.

By the time children reached 3 years of age, those numbers were still 24 percent and 6 percent, respectively.

Taking folic acid supplements seemed to make a big difference, however.

For kids whose mothers took folic acid, delayed language skills at 18 months of age were noted in 17 percent of children whose mothers had epilepsy, compared to 11 percent of those whose mothers did not have epilepsy.

The protective effect of folic acid appeared stronger for babies born to moms with epilepsy.

"Half of the risk of having language delays at 18 months could be attributed to the lack of folic acid in children exposed to epilepsy drugs," Husebye noted, "while in children of mothers without epilepsy only 6 percent of the risk was attributed to the lack of supplements."

"These results are important for women with epilepsy all over the world because many epilepsy drugs interact with the way folate is metabolized by the body, so we are still learning how much folic acid is needed for women with epilepsy and how it benefits their children," Husebye said in a news release from the journal Neurology. Her team published the findings Aug. 1 in the online issue of the journal.

The study was conducted in Norway, where foods do not have to be fortified with folic acid, which is required in the United States. Even so, folic acid supplements are recommended for pregnant women in the United States, experts said.

Dr. Fred Lado stressed that the study wasn't designed to prove cause-and-effect, but "the investigators controlled as much as possible for confounding variables."

"It is already widely accepted in the epilepsy community that folate supplementation reduces the risk of neural tube defects and likely other major birth defects in children of women receiving [epilepsy drugs]," said Lado, who is regional director for epilepsy services at Northwell Health in Queens and Long Island, N.Y.

"Moreover, there appears to be no risk [to] folate supplementation when used at usual doses," he noted.

The new findings "provide evidence that the benefits of folate supplementation extend into post-natal development of children," further strengthening the recommendation that women with epilepsy take the supplement, Lado said.

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