A recent study highlighted the importance of taking folic acid supplements for women with epilepsy whose medications put them at higher risk for pregnancy complications. This study reported that more than half of women were not taking folic acid supplements, regardless of whether they had epilepsy or not.
For women deciding to breasfeed, another study found that children who were breastfed weren't affected by their mothers being on antiepileptic medications.
These two different studies related to pregnancy in women with epilepsy were presented on December 9 at the American Epilepsy Society’s 67th Annual Meeting in Washington DC.
In one of the studies, Andrew Herzog, MD, from the Harvard Neuroendocrine Unit at Beth Israel Deaconess Medical Center in Boston, and colleagues examined whether women with epilepsy were taking folic acid supplements to reduce the risk of birth defects in case of pregnancy.
Dr. Herzog and team reported that antiepileptic medications, in particular valproate, can cause folic acid deficiency. Folic acid deficiency is linked with birth defects and pregnancy loss.
For their study, these researchers gathered data from 626 women with epilepsy between 18 and 47 years old.
Results showed that 44.7 percent of the participants took folic acid supplements.
There was no difference in folic acid intake between women who could become pregnant and those who could not because of infertility, hysterectomy, tubal ligation or male partners with vasectomy.
There also was no difference between women taking epileptic medication and those who were not taking medications.
The researchers found that 80 percent of the women who were trying to become pregnant were taking folic acid supplements. But only 46 percent of the women at risk for unintended pregnancy were taking folic acid supplements.
These women were considered at risk for unintended pregancy if they were sexually active and not known to have infertility, hysterectomy, tubal ligation or male partners with vasectomy.
These researchers also explored whether acid folic uptake was influenced by factors such as age, race, education, income insurance, seizure type and epileptic medication type.
They found that the only factor associated with folic acid intake was education. They estimated that 48.8 percent of the women who had an associate college degree or higher took folic acid, compared to 39 percent of the women without a college degree.
Dr. Herzog concluded, “Our findings show that only about half of the women surveyed are taking folic acid, despite their high risk of unintended pregnancies. Additionally, we found that many of the respondents who were not taking precaution of neural tube malformation were taking Valproate, a folic acid antagonist.”
The second study examined whether the level of intelligence was affected in those children who were breastfed by mothers taking epilepsy medications. This study was conducted by Kimford Meador, MD, from Neurology and Pediatrics at Emory University, and colleagues.
These researchers assessed mental abilities in 181 children of mothers who were taking one of the following antiepileptic medications: carbamazepine (brand names Tegretol, Equetro, Carbatrol), lamotrigine (Lamictal), phenytoin (Dilantin) or valproate (Depakote, Depakene, Depacon, Stavzor). The intelligence scores (IQ) for these children at age 6 were obtained.
All of the children’s mothers were using epilepsy medications. A total of 43 percent of them breastfed their kids while the other 57 percent did not.
Dr. Meador and team investigated different factors that could have an influence on the child’s intelligence score.
These researchers reported that the child's level of intelligence was influenced by the intelligence score of the mother, type of epilepsy medication, dose of medication, folic acid level of the mother and whether the child was breastfed or not.
Children who were breastfed by their mothers had higher intelligence scores (108) compared to children who were not breastfed (104).
Among the group of children who were breastfed, the highest score was among those whose mothers were taking lamotrigine (intelligence score of 114).
The average intelligence score for those children breastfed while their mothers were taking phenytoin and valproate was 105, and 108 for those taking carbamazepine.
“Our results are encouraging in that women with epilepsy can be less fearful of breastfeeding their baby. Nevertheless, this is a limited study and additional research is needed," Dr. Meador said.