Lack of Folic Acid Supplements During Pregnancy Linked With Increased Autism Risk in Children Exposed to Seizure Drugs In Utero Interview with:

Dr. Marte Bjørk, MD PhD Department of Clinical Medicine University of Bergen, Department of Neurology Haukeland University Hospital Bergen, Norway

Dr. Marte Bjørk

Dr. Marte Bjørk, MD PhD
Department of Clinical Medicine
University of Bergen,
Department of Neurology
Haukeland University Hospital
Bergen, Norway What is the background for this study?

Response: In utero antiepileptic drug exposure are associated with neurodevelopmental problems in the child. We looked into if maternal folate during pregnancy could reduce the risk of autistic traits in children of women in need of antiepileptic drugs in pregnancy. The rationale for the hypothesis that folate could be beneficial, was that many antiepileptic drugs interact with folate metabolism. Folic acid supplement use is also associated with slightly reduced risk of autism in children of women from the general population. What are the main findings?

Response: Children of women that used antiepileptic drugs but did also take folic acid supplements before pregnancy or in the first trimester had a much-reduced risk of autistic traits compared to children of women that did not use such supplements.

Children of the no-users of folic acid supplement had an adjusted odds ratio of 5.9 at the age of 18 months and 7.9 at 3 years compared to users of folic acid supplements. We also found that low plasma folate levels during pregnancy corresponded with a high degree of autistic traits in the child. What should readers take away from your report?

Response: Women that use antiepileptic drugs and that could get pregnant should take a low dose daily folic acid supplement. Folic acid use was most important before and early in pregnancy in our study. What recommendations do you have for future research as a result of this study?

Response: It is important to clarify the optimal dose of folic acid supplements in the periconceptional period as well as later in pregnancy (not necessarily the same dose). The effect of folic acid supplements on child development as well as on the risk of congenital malformations should also be investigated larger samples of children exposed to different kinds of antiepileptic drugs and drug combinations. Even though we found an effect of folic acid in all the antiepileptic drugs we investigated, the effect is not necessarily similar between different drugs. Different kinds of antiepileptic agents interact with folate absorption and metabolism in different ways. Is there anything else you would like to add?

Response: I would like to add that today most recommend women to start using folic acid supplements when they plan to get pregnant and throughout pregnancy.

However, we mainly found a beneficial effect of folic acid before conception and early in pregnancy. However, up to 79 % of pregnancies in this group is not planned. I worry that many of the unintended pregnancies are not recognized before the critical period has passed.
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Marte Bjørk, Bettina Riedel, Olav Spigset, Gyri Veiby, Eivind Kolstad, Anne Kjersti Daltveit, Nils Erik Gilhus. Association of Folic Acid Supplementation During Pregnancy With the Risk of Autistic Traits in Children Exposed to Antiepileptic Drugs In Utero. JAMA Neurol. Published online December 26, 2017. doi:10.1001/jamaneurol.2017.3897

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.


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Last Updated on December 27, 2017 by Marie Benz MD FAAD