Folic acid prevents language delays in children of Epileptic women

Antiepileptic drug (AED) taken by pregnant women for epilepsy treatment can increase the risk of language delays in children. Now, a new study published in the journal Neurology has found that the intake of folic acid supplements before and early in pregnancy can cut down this risk.

Elisabeth Synnøve Nilsen Husebye, the University of Bergen in Bergen, Norway, and colleagues conducted the study to examine the effect of maternal folic acid supplementation and maternal plasma folate and AED concentrations on language delay in AED-exposed children of mothers with epilepsy.

For the study, the researchers conducted an analysis of 335 children of mothers with epilepsy who took epilepsy drugs while they were pregnant and 104,222 children of mothers without epilepsy. Maintaining effective epilepsy treatment during pregnancy is important because seizures may cause harm to the fetus and the mother.

Maternal plasma folate and maternal plasma and umbilical cord AED concentrations were measured in blood samples from gestational weeks 17 to 19 and immediately after birth, respectively. Language development at 18 and 36 months was evaluated by the Ages and Stages Questionnaires.

Key Findings:

• Among the children whose mothers did not take folic acid, 34 percent of the children of mothers with epilepsy had delayed language skills at 18 months, compared to 11 percent of the children whose mothers did not have epilepsy.


• At three years old, 24 percent of the children of mothers with epilepsy had a delay in expressive language skills, compared to 6 percent of those with mothers without epilepsy.


• Among the children whose mothers did take folic acid, 17 percent of children of mothers with epilepsy had language delay at 18 months, compared to 11 percent in the control group.

The study found that among children whose mothers took epilepsy drugs while they were pregnant, those whose mothers did not take folic acid supplements were four times more likely to have delays in their language skills when they were 18 months old compared to children of mothers without epilepsy whose mothers did not take folic acid supplements. By three years old, those whose mothers took no supplements were nearly five times as likely to have language delays compared to children of mothers without epilepsy.

"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 Husebye.

Also Read: Prenatal Folic acid fortification prevents mental illness later: JAMA Study

Husebye also noted that the mothers of children exposed to epilepsy drugs with language delays started taking folic acid later in pregnancy, with the average starting at week 6.5 of pregnancy for those with language delay at 18 months. Mothers with children exposed to epilepsy drugs with no delays in language skills most often started taking folic acid three weeks before they conceived.

"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."

Husebye also noted that the critical period for supplementation to prevent language delays was from four weeks before the start of pregnancy until the end of the first trimester.

A limitation of the study was that the children's language skills were not assessed by a researcher but provided by the parents.

"Folic acid use early in pregnancy may have a preventive effect on language delay associated with in utero AED exposure.," concluded the authors.

For further information log on to https://doi.org/10.1212/WNL.0000000000006073