• Folic acid (vitamin B9) is a water-soluble B vitamin.
  • It is lost in traditional Indian cooking.
  • Folic acid is essential for DNA repair, cell division and normal cellular growth.
  • Profound deficiency of folic acid during pregnancy is associated with neural tube defects, such as spina bifida, in neonates.
  • Deficiency in adults has been associated with megaloblastic anemia and peripheral neuropathy.
  • In both men and women, low serum folate levels can increase homocysteine levels, which are correlated with elevated cardiovascular risk.
  • Low folic acid levels during pregnancy in women with epilepsy have been associated with fetal malformation and older enzyme-inducing anti-epileptic drugs (AEDs) are known to reduce serum folate levels.
  • The risk of having a pregnancy complicated by a major congenital malformation (e.g., neural tube defect) is doubled in epileptic women taking AEDs compared with those with a history of epilepsy not taking these agents.
  • Risk is tripled with AED polypharmacy, especially when valproic acid is included.
  • 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.
  • The guidelines recommend higher daily folic acid doses (4 mg/day) in women with a history of neural tube defects.
  • Enzyme-inducing anticonvulsants, such as phenytoin, carbamazepine, primidone and phenobarbital, are known to decrease folate levels, and valproic acid may interfere with folate metabolism.
  • Other AEDs, such as oxcarbazepine, lamotrigine and zonisamide, do not appear to alter folate levels.
  • 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.