Folic acid supplementation for women with epilepsy who might become pregnant.

Low folate levels are associated with an increased risk of spontaneous abortion and congenital malformations. Up to half of all pregnancies are unplanned, so official guidelines in a number of countries, including the US, recommend folic acid supplementation for all women who might become pregnant, before they actually start planning to have children. Children born to women who are taking antiepileptic medications, many of which antagonize folate action, are at an increased risk of birth defects. This article highlights a study by Pittschieler et al. that has suggested that supplementation with folic acid might be particularly important in women with epilepsy who are taking antiepileptic medications--especially valproate. However, the sample size in the study was too small to determine the optimum dose or to detect whether folic acid protects against birth defects. Nonetheless, it is clear that all women of reproductive age, especially those taking certain antiepileptic medications, should take folic acid supplements.