Pregnancy folate supplements

Anti-epileptic drugs, such as phenytoin, carbamazepine and valproate, may lead to neural tube defects if administered during pregnancy. Concurrent administration of folate supplements, such as folic acid, is recommended. 

Pregnancy the exact cause of malformations is difficult to establish as epilepsy itself may cause foetal malformations (neural tube, clef palate...). Folate supplementation is considered to have a preventive effect. 

Prevention of fetal neural tube defect (spina bifida). Folic acid supplementation taken before conception and during the early weeks of pregnancy has been shown in an 8-year trial to prevent the condition in pregnancies subsequent to an affected birth. Women hoping to conceive and who have had an affected child are advised to take folic acid 5 mg/day. To prevent a first occurrence 400 micrograms/day should be taken both before conception, or as soon as possible after diagnosis. In both cases folate supplement should be taken for the first 12 weeks of pregnancy. 

Folic acid (folate) is found in green leafy vegetables and is involved in one-carbon metabolism. Folate supplements are vital during pregnancy. Groups of women who are prescribed folic acid show a significant decrease in the incidence of neural tube defects in their newborns (5b). 

Mahomed K (2004) Iron and folate supplementation in pregnancy (Cochrane Review). In The Cochrane Library, Issue 2, 2004. Chichester John Wiley Sons, Ltd. 

Folate supplementation is often given in pregnancy where its deficiency can lead to birth defects resulting from defects in neural tube development such as spina bifida. 

Anyone taking diuretics for longer than six months may experience a folate, or folic acid, deficiency. Folic acid plays a part in the health and reproduction of virtually every cell in the body. It is responsible for protein metabolism, the prevention of neural tube defects in pregnancy, blood cell production, and the synthesis of neurotransmitters. Individuals with folate deficiencies may suffer from anemia, depression and other mood disorders, and may give birth to babies with neural tube defects. Supplementation with folic acid may be useful in reversing these effects. 

It is unlikely that an increase in folate intake equivalent to 400 /rg of free folic acid per day could be achieved from unfortified foods. Women who are planning a pregnancy are advised to take supplements. As discussed in Section 10.12, enrichment of cereal products with folic acid is now mandatory in some countries, mainly to reduce the incidence of neural tube defects. 

Premature infants. Supplementation is needed because these infants miss the build-up of folate stores that normally occurs in the last few weeks of pregnancy. 

Spina bifida is one of a class of birth defects characterized by the incomplete or incorrect formation of the neural tube early in development. In the United States, the prevalence of neural-tube defects is approximately 1 case per 1000 births. A variety of studies have demonstrated that prevalence of neural-tube defects is reduced by as much as 70% when women take folic acid as a dietary supplement before and during the first trimester of pregnancy. One hypothesis is that more folate derivatives are needed for the synthesis of DNA precursors when cell division is frequent and substantial amounts of DNA must be synthesized. 

---