Pregnant women with epilepsy need extra folate (a B vitamin) to protect their baby’s development, but doctors weren’t sure about the best dose. Researchers asked 52 epilepsy experts worldwide what they recommend. Most doctors suggest taking 1-2 milligrams of folic acid daily, which is higher than the standard recommendation for all pregnancies. Some doctors recommend even higher doses for women taking certain epilepsy medications. This survey shows that experts are moving away from very high doses and instead personalizing recommendations based on each woman’s specific situation, medications, and health conditions.

The Quick Take

  • What they studied: What dose of folic acid (a B vitamin) do epilepsy doctors recommend for pregnant women, and why?
  • Who participated: 52 epilepsy specialists from around the world, including doctors who treat adults with epilepsy, pediatric neurologists, pregnancy specialists, and pharmacists. Most were from North America and Europe.
  • Key finding: About 73% of doctors recommend 1-2 milligrams of folic acid daily for pregnant women with epilepsy. This is higher than the standard 0.4 milligrams recommended for all pregnancies. Additionally, 42% of doctors personalize the dose based on the woman’s specific epilepsy medication and health situation.
  • What it means for you: If you’re a woman with epilepsy planning pregnancy or currently pregnant, talk with your doctor about folic acid supplementation. Your doctor may recommend a higher dose than standard prenatal vitamins, especially if you take certain epilepsy medications. This personalized approach may help protect your baby’s development better than a one-size-fits-all dose.

The Research Details

Researchers created a survey and sent it to epilepsy experts who specialize in treating women of childbearing age. The survey asked doctors about their current practices and recommendations for folic acid dosing in pregnant women with epilepsy. Doctors could provide open-ended answers, allowing them to explain their reasoning and describe different scenarios.

The survey included questions about what dose they recommend, whether they adjust doses based on the woman’s epilepsy medication, and whether they test blood folate levels to guide their recommendations. Responses were organized by dose ranges and clinical situations to identify patterns in expert opinion.

This approach is valuable because it captures real-world clinical practice from experienced specialists rather than relying on limited research studies. It helps identify current trends in medical practice and areas where expert opinion varies.

There’s no perfect research study comparing different folic acid doses in pregnant women with epilepsy and their babies’ outcomes. This creates uncertainty about the best dose. By surveying experts, researchers can understand what experienced doctors have learned from their patients and identify consensus or disagreement. This information helps guide clinical practice and highlights where more research is needed.

This survey captures expert opinion rather than testing actual outcomes, so it shows what doctors believe is best based on their experience, not definitive proof. The respondents were primarily from regions with mandatory food fortification (North America) and some from Europe and Asia, so recommendations may vary by region. The relatively small number of respondents (52) means these findings represent expert consensus but not necessarily all epilepsy specialists worldwide. The survey didn’t test whether following these recommendations actually leads to better baby outcomes.

What the Results Show

The most common recommendation was 1-2 milligrams of folic acid daily, endorsed by 73% of responding doctors. Within this group, 24 doctors recommended 1 milligram of folic acid alone, while 12 doctors recommended 1 milligram of folic acid combined with prenatal vitamins. This represents a shift from older practices that recommended higher doses.

A smaller group of doctors (15%) recommended lower doses of 0.4-0.8 milligrams daily, which is closer to standard prenatal vitamin recommendations. However, nearly half of all doctors (42%) said they would personalize the dose based on individual patient factors rather than using a standard dose for everyone.

When personalizing doses, doctors most commonly recommended higher amounts for women taking valproate, a specific epilepsy medication known to interact with folate. About 37% of doctors mentioned adjusting doses upward for valproate users. Some doctors also recommended higher doses for women on other epilepsy medications that speed up how the body processes folate.

Very few doctors (only 2%) routinely tested blood folate levels to guide their recommendations. This suggests that most doctors rely on clinical judgment and general guidelines rather than individual blood test results. The survey also revealed that doctors consider multiple factors when deciding on folic acid dose, including the woman’s diet, whether her country fortifies food with folate, her genetic background, her specific epilepsy medications, and other health conditions like anemia or obesity.

This survey shows that expert practice has evolved. Older guidelines sometimes recommended very high folic acid doses (5 milligrams or more) for pregnant women with epilepsy. The current expert consensus favors lower doses (1-2 milligrams) combined with personalized adjustments. This shift likely reflects growing understanding that very high doses aren’t necessary and that individualized approaches work better than one-size-fits-all recommendations.

This study captures what experts say they do, not what they actually do in every case. Doctors’ actual practices may differ from their survey responses. The survey didn’t follow pregnant women and their babies to see which dosing strategies led to the best outcomes. Most respondents were from regions with food fortification, so recommendations might differ in countries without fortified foods. The small sample size means these findings represent a snapshot of expert opinion rather than definitive guidance. The survey didn’t include input from pregnant women with epilepsy themselves about their experiences and preferences.

The Bottom Line

If you’re a woman with epilepsy who is pregnant or planning pregnancy: (1) Take folic acid supplementation as recommended by your doctor—don’t skip it or assume standard prenatal vitamins are enough. (2) Tell your doctor about all epilepsy medications you take, as some require higher folic acid doses. (3) Discuss your diet and any other health conditions that might affect folate needs. (4) Most experts recommend 1-2 milligrams daily, but your doctor may recommend a different dose based on your individual situation. Confidence level: Moderate—this represents expert consensus but isn’t based on direct comparison of outcomes.

This research is most relevant to: women with epilepsy who are pregnant or planning pregnancy; doctors who treat women with epilepsy; obstetricians caring for pregnant women with epilepsy. This doesn’t apply to women without epilepsy, who should follow standard prenatal vitamin recommendations. Women with epilepsy should not adjust their folic acid dose without talking to their doctor.

Folic acid works throughout pregnancy to support your baby’s development, particularly in the first few weeks when the baby’s nervous system is forming. You should start taking folic acid before becoming pregnant if possible, or as soon as you know you’re pregnant. Benefits develop over weeks and months of consistent use, not days. You’ll likely take folic acid throughout your entire pregnancy.

Want to Apply This Research?

  • Track daily folic acid supplementation intake (dose in milligrams and time taken) to ensure consistency. Also log any changes in epilepsy medications, as these may affect folic acid needs.
  • Set a daily reminder to take your folic acid supplement at the same time each day (such as with breakfast). If your doctor changes your epilepsy medication during pregnancy, update your folic acid dose reminder and log the change in the app.
  • Monitor adherence to folic acid supplementation throughout pregnancy. Track any side effects or concerns to discuss with your doctor. Note any medication changes and corresponding dose adjustments. Log prenatal appointment dates and any lab work related to folate levels if your doctor orders testing.

This research summarizes expert opinions on folic acid dosing for pregnant women with epilepsy but does not provide personalized medical advice. Folic acid dosing should be determined by your individual healthcare provider based on your specific epilepsy medications, health conditions, and circumstances. Do not change your folic acid dose or epilepsy medications without consulting your doctor. This information is for educational purposes and should not replace professional medical guidance. Pregnant women with epilepsy should work closely with their healthcare team, including their neurologist and obstetrician, to develop a personalized treatment plan.