Folic acid supplementation may prevent adverse offspring outcomes in ASM-exposed pregnancies

In pregnant women exposed to antiseizure medications (ASMs), supplementation with folic acid helps lower the risk of adverse offspring outcomes, according to a study.

The analysis involved 1,209 pregnancies in 1,013 women with epilepsy recruited across 58 hospitals in China. ASM and folic acid exposures during preconception and first trimester of pregnancy were determined.

The primary outcome was a composite of preterm birth, low birth weight (LBW), major congenital anomalies, foetal death, and neurodevelopmental delay.

Of the participants, 952 received folic acid. Folic acid supplementation in ASM-exposed pregnancies was associated with 41-percent reduced odds of composite adverse offspring outcomes (adjusted odds ratio [aOR], 0.59, 95 percent confidence interval [CI], 0.387–0.911) and 87-percent lower odds of foetal death (aOR, 0.127, 95 percent CI, 0.054–0.296). The findings were similar regardless of whether folic acid supplementation was initiated prior to conception or during the first trimester of pregnancy.

Looking at doses, supplementation with 0.4 mg of folic acid daily was associated with reduced odds of foetal death (aOR, 0.185, 95 percent CI, 0.078–0.428) compared with no supplement. Supplementation at doses exceeding 0.4 mg per day yielded further reduction in the risk of composite adverse outcomes (aOR, 0.343, 95 percent CI, 0.162–0.675), while doses above 1 mg showed a trend toward decreased odds of preterm birth (aOR, 0.338, 95 percent CI, 0.104–0.943).

Finally, supplementation at doses >1 mg vs 0.4 mg per day was associated with lower odds of LBW (aOR, 0.208, 95 percent CI, 0.05–0.58).