Folic acid supplementation low among women with epilepsy


AT AES 2013

WASHINGTON – Only about 43% of reproductive-age women with epilepsy who completed a Web-based survey were taking a folic acid supplement, according to interim findings from the Epilepsy Birth Control Registry.

Furthermore, only 46% of those considered to be at risk for becoming pregnant (for example, those who were sexually active and who had no history of infertility) reported taking a folic acid supplement, and among respondents who were taking antiepileptic drugs (AEDs), the lowest rate of folic acid supplement use (25%) was in those taking valproate, a folic acid antagonist, Dr. Andrew G. Herzog reported at the annual meeting of the American Epilepsy Society.

Folic acid deficiency is known to be associated with fetal loss and risk of neural tube defects, and valproate is the AED associated with the highest risk of neural tube malformations, said Dr. Herzog of Harvard Medical School, Boston, and Beth Israel Deaconess Medical Center, Wellesley, Mass.

However, respondents taking valproate in this study were the least likely to have a college degree, and having a college degree was found to be associated with greater likelihood of taking a folic acid supplement. In fact, having an associate college degree or higher was the only significant demographic predictor of folic acid use; 50% of those with a college degree were taking folic acid, compared with 39% of those without a college degree, and those with an advanced degree were twice as likely as those with only a high school education to be taking folic acid, but the numbers were insufficient for determining whether AED type or education level predicted folic acid use, Dr. Herzog noted.

Study subjects were women with epilepsy aged 18 to 47 years. The first 650 to complete the survey at the registry site were included in the analysis.

Prior findings from the registry showed that this is largely a population at high risk for pregnancy; about 60% of pregnancies among respondents were unintended, compared with about 47% in the general population, he said.

Dr. Andrew G. Herzog

Yet, the only category of respondents for which folic acid use was more than 50%, including, for example, those at risk for pregnancy, those not at risk for pregnancy, those using birth control, those not using birth control, and those trying to become pregnant, was the latter – those women actively trying to become pregnant, of whom 70% were taking folic acid, he said.

Factors including age, seizure type, and insurance status were not associated with folic acid use.

Importantly, seeing a health care professional within the year prior to the survey also was not associated with increased folic acid use.

This is concerning, given that it has been known for three decades that folic acid deficiency is associated with serious consequences, Dr. Herzog said, suggesting that education about the importance of supplementation may get pushed aside by busy physicians focused more on seizure activity and epilepsy treatment.

Dr. Herzog reported having no disclosures.

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