The Importance of Supplementation Before & During Pregnancy

Creating the optimal environment for a developing fetus is a critical part of pregnancy planning for all those considering becoming pregnant. For patients with epilepsy — who have additional risk factors to consider — a healthy supplementation routine can help reduce certain risks and promote healthy pregnancy outcomes.

Folic acid supplementation is recommended in all people with epilepsy with childbearing potential, regardless of immediate plans for pregnancy. Ideally, patients should start taking prenatal supplements before trying to get pregnant, so discuss the benefits of supplementation with patients of childbearing years as soon as possible. It is important that the person begins supplementing with folic acid well before pregnancy and continues it throughout pregnancy, while breastfeeding, and between babies.

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The Value of Folic Acid During Childbearing Years

Patients should take folic acid daily. Because some studies found that up to 65% of women with epilepsy reported at least one unplanned pregnancy, clinicians should start patients on folic acid as soon as the patient enters their childbearing years.  

The benefits of folic acid supplementation during pregnancy are well-documented:

  • Periconceptual folic acid has been associated with lower risk of neural tube defects in the general population.
  • Beginning periconceptual folic acid prior to conception has been associated with improved cognitive/behavioral outcomes in both patients with epilepsy and the general population.

Recommendations for Folic Acid Dosage

All patients with epilepsy and childbearing potential should take at least 400-1000 mcg of folic acid daily, which can be a prescription (offered in the United States as tablets). This supplementation should continue throughout their childbearing years, including pregnancy, breastfeeding, and between babies.

If the patient isn’t on either folic acid or prenatal vitamins prior to pregnancy, both should be started immediately upon detection of pregnancy.

NOTE:  A family history of epilepsy or a prior child with a neural tube defect may warrant a higher dosage of folic acid. Consult with the patient’s neurologist/epilepsy specialist and OB-GYN to get the patient’s complete history and make a specialized plan.

Consider Additional Supplementation

Folic acid isn’t the only supplement recommended during pregnancy. Advise your patients to also:

  • Begin taking a prenatal vitamin three months prior to trying for pregnancy (this will add 800-1000 mcg of folic acid).
  • Have their B12 levels checked to ensure folic acid supplementation is not masking a B12 deficiency and supplement accordingly.
  • Have their vitamin D levels checked ahead of (or even during) pregnancy planning/once pregnant and supplement accordingly.

Guide Your Patients

Folic acid supplementation (and later prenatal vitamins and other supplements) is a critical step to creating the best possible environment for a developing fetus and a healthy baby. Due to the high risk of unplanned pregnancy, folic acid should be prescribed and emphasized even before pregnancy planning.

Most major health insurers cover prenatal supplements. Encourage your patients to check their plans and consult with their insurance providers. Folic acid (and prenatal vitamins) should be addressed as part of pregnancy planning discussions that include other planning steps like switching to a lower-risk ASM that set the patient up for better outcomes. 

Reviewed by: Laura Kirkpatrick, MD, August 2023