Folic acid (vitamin B9), first successfully isolated in spinach leaves in 1941, can be used to treat megaloblastic anemia, and with the development of people's understanding of the role of folic acid, it has been clear that for women who are trying to conceive and become pregnant, a daily intake of a certain amount of folic acid can prevent neural tube malformations in the baby. Neural tube malformations are a serious birth defect that occurs early in embryonic development and has a high rate of disability and mortality. Fortunately, by increasing the intake of folic acid early, the incidence of this disease can be greatly reduced.
Pregestal seizure control in women with epilepsy is closely correlated with worsening epilepsy during pregnancy. If the epilepsy is well controlled in the first 9 months of pregnancy, there is generally no recurrence during pregnancy. If the patient has a single seizure type and normal neurologic and EEG, antiepileptic drugs should be discontinued gradually 9 months before pregnancy. For patients who need to continue medication, the drug and dose should be individually adjusted.
In addition, care should be taken to supplement folic acid. Previous studies have reported that in women with epilepsy who are taking antiepileptic drugs, starting folic acid supplementation before pregnancy is important to reduce the risk of neurodevelopmental problems and autism in their offspring.
Preparation for pregnancy is important
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Q: Planning to become pregnant, the doctor recommends starting to take folic acid tablets, why is this?
A: Patients with epilepsy often need to take drugs for a long time to control their condition. Studies have shown that some antiepileptic drugs (phenytoin, carbamazepine, topiramate) can cause a decrease in the level of folic acid in the human body, which may be related to the absorption and metabolism of folic acid by antiepileptic drugs. The increased demand for folic acid in the human body during pregnancy has exacerbated the relative shortage of folic acid in the human body. Women with pregnancy plans should supplement folic acid in advance, usually three months in advance. If you supplement folic acid when you find out you are pregnant, it is likely that it will be too late.
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Q: If a female with epilepsy is planning to become pregnant, how can I supplement folic acid?
A: Folic acid can not be synthesized in the human body, can only be exogenous intake, eat more folic acid-rich foods to help its supplement. Natural folic acid is abundantly present in foods such as dark green vegetables, citrus fruits, beans, nuts, and animal livers, but it can be lost by 80% of food processing and storage processes such as light and heating. And the natural folic acid bioavailability is low, only about 60% of the synthetic folic acid. Therefore, in the case of a limited total daily dietary intake, it can be appropriate to supplement by taking synthetic folic acid, but care should be taken to estimate the total daily folic acid intake, because long-term, excessive intake of folic acid is also unfavorable to the body.
Folic acid supplements may be larger than normal women in women with epilepsy, especially those taking phenytoin, canazepine, or phenobarbital, as these drugs can affect the absorption of folic acid. In addition, an increase in folic acid supplementation is also recommended for patients taking multiple antiepileptic drugs or taking greater than 1,000 mg of valproic acid per day. If there have been cases of neural tube malformations in children born in the past, the amount of folic acid supplementation should be increased accordingly. Mainland guidelines recommend that for women of reproductive age with epilepsy, folic acid is supplemented with 0.8-1.0 mg daily from the possible pregnancy or at least 3 months before pregnancy until the end of 3 months of pregnancy.