Hey there! So, let’s chat about folic acid, especially if you’re considering pregnancy. Recently, Dr. Kim reached out with a question about a patient on medication for seizures. She wondered if increasing folic acid intake would help reduce the risk of birth defects. It’s a valid concern, and the guidance can be a bit confusing!
Folic acid is the synthetic version of folate, which is a B9 vitamin essential for creating new cells. It plays a crucial role in lowering the risk of neural tube defects (NTDs) like spina bifida, which affect the brain and spinal cord. Since the neural tube develops early in pregnancy—around 4 to 6 weeks after the last menstrual period—it’s vital for women who could get pregnant to start taking folic acid at least a month before conception.
In the U.S., many foods like bread, pasta, and cereals are fortified with folic acid, and this has helped decrease NTDs by 35%, according to the CDC. We also get natural folate from foods such as leafy greens and nuts, but only about half of it can be absorbed by the body, which is why supplements are often recommended.
How Much Folic Acid Do You Really Need?
The CDC suggests that all women of reproductive age take at least 400 mcg (0.4 mg) daily. Once pregnant, the recommendation increases to 600-800 mcg (0.6 to 0.8 mg) per day. This dosage is typically found in most prenatal vitamins, and higher amounts aren’t generally recommended.
However, if someone has had a previous pregnancy with an NTD, the CDC and the American College of Obstetricians and Gynecologists (ACOG) suggest upping that to 4,000 mcg (4 mg) daily, starting at least a month before conception and continuing through the first trimester.
Considerations for Women on Anti-Epileptic Drugs
Now, back to Dr. Kim’s patient on an anti-epileptic drug (AED). Some AEDs can hinder the absorption of folic acid, potentially increasing the risk of NTDs if a pregnancy occurs. Yet, there’s limited research that confirms whether taking extra folic acid would actually reduce that risk.
Professional organizations are somewhat divided on this topic. The American Academy of Neurology and the American Epilepsy Society recommend at least 400 mcg of folic acid daily for all women of childbearing age, with insufficient evidence to support higher doses for those on AEDs. ACOG advises higher doses for women at increased risk, such as those with seizure disorders. Meanwhile, the CDC’s stance is more cautious, suggesting higher doses only for women with a history of NTDs.
What Should Dr. Kim Do?
A thorough discussion about the risks and benefits of increasing folic acid intake is essential for her patient, especially since she was on carbamazepine, a known folic acid antagonist. Ultimately, it’s crucial to weigh the pros and cons, as high doses of folic acid aren’t well-studied in pregnancy and could mask other deficiencies.
In the end, keeping updated on recommendations can be tricky, so it’s always wise to consult with healthcare professionals like those at Make A Mom for answers. If you’re curious about pregnancy and home insemination, check out this resource for more information.
In summary, while folic acid is vital for pregnancy, the right dosage can vary, especially for women on certain medications. It’s best to have a personalized consultation to navigate these nuances effectively.