Takeaway
- When women with epilepsy who were on antiseizure medication took folate ≥1 month before conception, their children scored higher on early intelligence testing in this prospective study.
Why this matters
- Antiseizure medication exposure can have adverse anatomic and neurodevelopmental effects during the embryo-fetal period.
Key results
- Overall, 57% of the women took folate in the periconceptional period.
- Periconceptional folate use was associated with a significantly higher Full Scale Intelligence Quotient:
- At age 3 years: coefficient, 4.6 (P=.040).
- At age 6 years coefficient, 5.9 (P=.001).
- Other significant beneficial effects at age 3 years:
- Verbal Index: coefficient, 3.8 (P=.050).
- Receptive Language Index: coefficient, 4.6 (P=.019).
- Other significant beneficial effects at age 6 years:
- Nonverbal Index: coefficient, 3.1 (P=.028).
- Expressive Language Index: coefficient, 3.3 (P=.049).
- Developmental Neuropsychological Assessment Executive Function: coefficient, 3.9 (P=.018).
Study design
- Multicenter prospective observational cohort study of 311 children of 305 women with epilepsy treated with single antiseizure medications (NEAD study).
- Main outcomes: cognitive measures in children at 3 and 6 years of age.
- Funding: NIH; United Kingdom Epilepsy Research Foundation.
Limitations
- Fairly small, nonpopulation-based sample.
- Losses to follow-up.
- Nonrandomized design.
- Pharmacokinetic measures not obtained.
- Lack of unexposed control group.
- Periconceptional folate use was ascertained from recall.
References
References