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eWellness: Folic Acid Update

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Dr KK Aggarwal    10 April 2018

  1. Folic acid (vitamin B9) is a water–soluble B vitamin.
  2. It is lost in traditional Indian cooking.
  3. Folic acid is essential for DNA repair, cell division and normal cellular growth.
  4. Profound deficiency of folic acid during pregnancy is associated with neural tube defects, such as spina bifida in neonates.
  5. Deficiency in adults has been associated with megaloblastic anemia and peripheral neuropathy.
  6. In both men and women, low serum folate levels can increase homocysteine levels, which are correlated with elevated cardiovascular risk.
  7. Low folic acid levels during pregnancy in women with epilepsy have been associated with fetal malformation and older enzyme–inducing anti-epileptic drugs are known to reduce serum folate levels.
  8. The risk of having a pregnancy complicated by a major congenital malformation (e.g., neural tube defect) is doubled in epileptic women taking anti-epileptic drugs compared with those women with a history of epilepsy not taking these agents.
  9. Risk is tripled with anti–epileptic drugs polypharmacy, especially when valproic acid is included.
  10. Consensus statements recommend 0.4–0.8 mg of folic acid per day in all women planning a pregnancy. Ideally, this should be started at least 1 month prior to pregnancy if possible.
  11. The guidelines recommend higher daily folic acid doses (4 mg/day) in women with a history of neural tube defects.
  12. Enzyme–inducing anticonvulsants, such as phenytoin, carbamazepine, primidone and phenobarbital, are known to decrease folate levels, and valproic acid may interfere with folate metabolism.
  13. Other AEDs such as oxcarbazepine, lamotrigine and zonisamide, do not appear to alter folate levels.
  14. Because many pregnancies are unplanned, it is recommended that folic acid supplementation be given routinely to all women of childbearing potential at 0.4 mg/day.

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