Folic Acid can Prevent Language Delays in Children of Mothers With Epilepsy

Taking folic acid supplements by women who are on anti-epileptic medications even before the start of pregnancy and continuing until the completion of 12 weeks or first trimester can significantly reduce the risk of language delays in their babies, according to a recent study conducted in Norway Epilepsy, a neurological disorder, where the person suffers from 2 or more apparently unprovoked seizures at an interval of at least 24 hours. The findings of the study appear in the online issue of Neurology®, the medical journal of the American Academy of Neurology.

Folic Acid Supplements during Pregnancy

In Norway, it is not compulsory for foods to be fortified with folic acid, unlike the US where it is compulsory. Even if foods are fortified, additional folic acid supplements are recommended during pregnancy in the US. This study in Norway aimed to evaluate:

• The effects of anti-epileptic medications taken by the mother during pregnancy on the language skills in the baby and
• Whether taking folic acid supplements had any protective effect on the fetus from the harmful effects of the medication

"These results are important for women with epilepsy all over the world because many epilepsy drugs interact with the way folate is metabolized by the body, so we are still learning how much folic acid is needed for women with epilepsy and how it benefits their children," said study author Elisabeth Synnøve Nilsen Husebye, MD, of the University of Bergen in Bergen, Norway.

Role of Folic Acid on Baby’s Speech Development

The study enrolled 335 children of mothers with epilepsy (seizures) who were taking epilepsy drugs during pregnancy and 104,222 children of mothers without epilepsy.

The study team gathered data on the use of epilepsy medications and folic acid supplements. Parents filled out forms about their children's speech and language development skills at 18 months and three years.

The key findings of the study were as follows:

• At 18 months, 34 percent of the children born to mothers on antiseizure medications who did not take folic acid supplements during pregnancy had delayed language skills, compared to 11 percent of the children whose mothers did not suffer from epilepsy
• At three years of age, 24 percent of the children of mothers with epilepsy (who did not take folic acid supplements), had a delayed speech or speech difficulties, compared to 6 percent of children with mothers who did not have epilepsy
• Among the children whose mothers were on anti-epileptic drugs and also took folic acid during pregnancy, 17 percent of children had language delay at 18 months, compared to 11 percent in the control group.
• The results remained unchanged even after the team considered other factors that could influence language skills, such as smoking and alcohol use in pregnancy, education level of the parents and premature birth
• Mothers of babies with speech difficulties at 18 months despite taking folic acid supplements were found to have started folic acid later in pregnancy, the average starting week being 6 1/2 weeks of pregnancy
• Mothers with children exposed to epilepsy medications during pregnancy with no delays in language skills had mostly started taking folic acid three weeks before planned pregnancy

Thus the findings of the study suggest that women who are on antiepileptic drugs can prevent speech delays and language problems in their babies by taking folic acid supplements even before a planned pregnancy.

One possible demerit of the study was that the language skills of the babies were not assessed by the study team or health professional but provided by the parents.

"The apparently protective effect of taking folic acid supplements was striking," Husebye said. "Half of the risk of having language delays at 18 months could be attributed to the lack of folic acid in children exposed to epilepsy drugs, while in children of mothers without epilepsy only 6 percent of the risk was attributed to the lack of supplements."

References:

1. Epilepsy and pregnancy - (https://www.healthnavigator.org.nz/health-a-z/e/epilepsy-and-pregnancy/)
2. Information About Epilepsy and Pregnancy - (https://familydoctor.org/epilepsy-and-pregnancy/)
3. Sima I. Patel and Page B. Pennell., "Management of epilepsy duringpregnancy: an update" (2015) Mar; 9(2): 118–129. Dec 27. doi: 10.1177/1756285615623934

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Source-Medindia