Epilepsy in Pregnancy: Is Prenatal Dietary Folate Sufficient to Improve Cognitive Outcomes in Offspring?
BACKGROUND AND PURPOSE:
Sadat-Hossieny et al. (Epilepsy & Behavior, 2021) evaluated the effect of dietary folate and folic acid on children exposed to anti-seizure medication in utero
Retrospective analysis of a prospective observational study
The Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) study (1999 to 2004)
Prospective, observational and assessor-blinded study
25 epilepsy centers in the US and UK
Women with epilepsy taking anti-seizure medication during pregnancy and their children
Use of one of 4 antiepileptic drugs: Valproate | Lamotrigine | Carbamazepine | Phenytoin
Nutrient intake obtained using Block Food Frequency Questionnaire-98
Cognitive outcome of children was evaluated at the ages of 2, 3, 4.5, and 6 years
Results adjusted for: Anti-seizure medication use | Maternal IQ | Anti-seizure medication standardized dose | Prepregnancy BMI | Daily Calories
Child IQ at age 6 and association with maternal prepregnancy nutrient levels
311 women | 305 children
Folic acid supplementation dose: 0 mg to >4 mg
Higher IQ at 6 years was associated with
Folate supplementation during the periconceptual period (P< 0.001)
Folate from food plus folate supplements (P< 0.001)
There was no association between IQ at 6 years and the following
Folate from food alone without supplementation (P=0.187)
Other nutrients from food and supplements: Vitamin C | Vitamin D | Vitamin E | Omega 3 | Gamma Tocopherol | Vitamin B12
Folate derived from fortified foods without folic acid vitamin supplementation was not associated with improved cognitive outcomes in children exposed to anti-seizure medication in utero
The authors conclude
The findings of the current study underscore the importance of folic acid supplementation for women with epilepsy taking ASMs, supporting prior research in the field
… folates (i.e., natural folate and folic acid) present in food, even in countries like the United States where food is fortified with folic acid, is not sufficient to produce positive cognitive effects in children of women with epilepsy taking anti-seizure medications
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan