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WASHINGTON -- About half of epileptic women taking anti-seizure drugs who could have become pregnant said they were not taking the recommended folic acid supplements, results of a survey found.
Among 400 participants in a web-based registry of women of childbearing age with epilepsy who responded to a survey and who were considered to be at risk for pregnancy, 185 (46%) reported taking folic acid supplements, according to Andrew Herzog, MD, of Beth Israel Deaconess Medical Center in Boston.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
The percentage was nearly identical (47%) in the 385 at-risk women taking anti-seizure medications, Herzog told attendees at the American Epilepsy Society annual meeting here.
The survey also asked whether participants had seen a healthcare provider in the previous year, and what kind of provider. "There was no significant difference in the relative frequency of folic acid use" between those reporting having seen a provider (44%) and those who didn't (40%), Herzog said.
He added that respondents who had seen OB/GYN specialists or neurologists had the same low rates of folic acid use as others in the study, and called for an educational campaign to educate providers as well as patients about the need for supplements in patients who may become pregnant.
Many of the most common anti-epileptic drugs act as folic acid inhibitors, Herzog explained, which in turn creates a high risk that any resulting pregnancies may spontaneously abort or lead to neural tube defects in those resulting in a live birth.
So-called enzyme-inducing drugs such as phenytoin, carbamazepine, and oxcarbazepine can create folic acid deficiency. Another major anti-seizure drug, valproate, acts as a folic acid antagonist.
In both cases, guidelines recommend folic acid supplementation for women of childbearing age who may become pregnant. Labels for valproate, but not other drugs, include such a recommendation as well.
To examine the real-world use of supplements in such women, Herzog and colleagues sent a survey to participants in the Epilepsy Birth Control Registry, an educational and research-oriented project developed by Herzog and two researchers at Columbia University in New York City. Participants sign up voluntarily at the project's website, where they are invited to complete the survey.
Of the first 650 to complete the survey, 400 were determined to be at risk of pregnancy and otherwise qualified for the analysis. These women reported that they were sexually active with no evidence of infertility or history of procedures that would permanently prevent pregnancy. They were also asked whether their sex partners were fertile. Participants indicating they used contraception (382) were still considered to be at risk for pregnancy.
The lone subgroup that showed a relatively high rate of folic acid use was women not using contraception and actively trying to become pregnant. In these 10 participants, seven reported taking supplements. However, the number was too low to qualify as a significant predictor of folic acid use.
There was one such predictor, Herzog said: having a college degree. Exactly 50% of those reporting one said they were taking supplements, compared with 39% of those with less education (P=0.006).
Women on valproate had an especially low rate of folic acid use (25%, P<0.01 versus enzyme-inducing drugs), Herzog reported.
But education may have accounted for at least part of that difference, he suggested -- - only 30% of the respondents using valproate had college degrees, compared with 50% of the respondents using enzyme-inducing agents (P=0.03). The researchers have not conducted a multivariate analysis to identify independent predictors of folic acid use.
Another limitation of the study was that the survey did not collect information on folic acid doses. On the other hand, he said, most commercial folic acid tablets and multivitamins contain the same 400-mcg dose.
He said the most concerning finding in the study was that seeing a healthcare provider did not appear to increase the likelihood that at-risk women would use supplements -- suggesting that providers may not be emphasizing the importance of supplements, or that many women fail to grasp it.
"It may be time for a campaign by pharmaceutical companies, providers, and epilepsy organizations," he said.
Disclosures
The study had no commercial funding.
Herzog declared no relevant financial interests.
Primary Source
American Epilepsy Society
Herzog A, et al "Folic acid use by women with epilepsy: interim analysis of the Epilepsy Birth Control Registry" AES 2013; Abstract B.04.