Women with epilepsy often don’t get enough folate, a B vitamin that’s crucial for healthy pregnancies. Researchers reviewed over 100 studies to understand why this happens and what can be done about it. They found that many factors contribute to low folate levels—from epilepsy medications to not taking vitamin supplements, poor diet, and lack of doctor counseling. The good news is that doctors now understand the problem better and can help women get adequate folate before and during pregnancy to protect both mother and baby.

The Quick Take

  • What they studied: Why women with epilepsy often have low levels of folate (a B vitamin) and why many don’t take folic acid supplements
  • Who participated: This review looked at 105 research studies involving women with epilepsy from around the world
  • Key finding: More than half of women with epilepsy don’t take folic acid supplements before getting pregnant, and many have low folate levels due to multiple reasons including their seizure medications, diet, and lack of medical guidance
  • What it means for you: If you’re a woman with epilepsy who might become pregnant, talk to your doctor about checking your folate levels and taking supplements. Low folate can increase risks for birth defects and pregnancy complications, but this is preventable with proper planning and care.

The Research Details

Researchers conducted a scoping review, which means they searched through medical databases to find all available studies about folate deficiency in women with epilepsy. They looked at 3,778 different research articles and selected 105 that had relevant information. This type of review helps summarize what we know about a topic by gathering evidence from many different studies.

The researchers organized their findings to identify common reasons why women with epilepsy develop folate deficiency and to understand what prevents women from taking folic acid supplements. They looked for patterns across studies to see which women were most likely to have low folate and which were least likely to take supplements.

This approach is valuable because it brings together information from many different research teams and countries, giving a comprehensive picture of the problem rather than relying on just one or two studies.

A scoping review is the right approach for this question because folate deficiency in women with epilepsy is a complex problem with many causes. By reviewing all available research together, doctors and researchers can see the full picture of what’s happening and identify gaps in our knowledge. This helps guide future research and clinical practice improvements.

This review was published in Brain, a highly respected medical journal, which means it went through expert review. The researchers followed established guidelines for conducting scoping reviews (PRISMA standards), which makes the process transparent and reliable. However, the quality of the conclusions depends on the quality of the 105 studies they reviewed—some studies may have been stronger than others. The review identifies that significant knowledge gaps still exist, which is honest and helpful for readers.

What the Results Show

The review found that folate deficiency is common among women with epilepsy, though the exact percentage varies across studies. Many women with epilepsy have lower folate levels than recommended for healthy pregnancy.

A major finding is that more than half of women with epilepsy don’t take folic acid supplements before they become pregnant. This is concerning because folic acid is most important during the earliest weeks of pregnancy, often before a woman knows she’s pregnant.

The researchers identified multiple reasons for low folate in women with epilepsy: some seizure medications interfere with how the body uses folate; many women don’t eat enough folate-rich foods; some have genetic variations that affect folate metabolism; and many don’t receive counseling from doctors about the importance of supplements. Additionally, some countries don’t fortify foods with folic acid like others do.

The review also found that certain groups of women with epilepsy are at higher risk for not taking folic acid supplements: those with unplanned pregnancies, lower education levels, lower income, those from ethnic minority groups, younger women, and those who haven’t been counseled about the importance of folate. Interestingly, women not currently taking seizure medications were less likely to take folic acid supplements, possibly because they didn’t realize the risk still applies to them.

This review builds on previous knowledge by comprehensively organizing what we know about folate deficiency in women with epilepsy. It confirms that this is a real and widespread problem, not just an isolated concern. The review shows that the issue involves both medical factors (medications, metabolism) and social factors (education, counseling, access to care), which is a more complete understanding than earlier research suggested.

This review has several important limitations. First, it only summarizes what other studies found—it doesn’t conduct new research itself. Second, the 105 studies included varied widely in quality and how they measured folate levels, making it hard to compare results directly. Third, the review doesn’t provide exact numbers on how common folate deficiency is because studies defined and measured it differently. Finally, there may be publication bias, meaning studies showing a problem are more likely to be published than studies showing no problem, which could make the issue seem more common than it actually is.

The Bottom Line

Women with epilepsy who could become pregnant should: (1) Talk to their doctor about checking folate levels before trying to get pregnant (high confidence); (2) Take folic acid supplements as recommended by their doctor, typically starting before conception (high confidence); (3) Eat folate-rich foods like leafy greens, beans, and fortified cereals (moderate confidence); (4) Discuss their seizure medications with their doctor, as some may affect folate absorption (high confidence). The review suggests that one-size-fits-all dosing may not work—some women may need higher doses based on their individual situation.

This research is most important for: women with epilepsy of childbearing age, especially those planning pregnancy or at risk for unplanned pregnancy; their doctors and neurologists; and women’s health providers. It’s also relevant for public health officials and policymakers working on maternal health. Women with epilepsy who have completed childbearing may be less affected, though maintaining adequate folate is still important for overall health.

Folate levels can improve within weeks to months of starting supplements, but it’s best to have adequate levels before becoming pregnant. Ideally, women should start folic acid supplements at least one month before trying to conceive, though earlier is better. Once pregnant, maintaining adequate folate throughout pregnancy is important for preventing birth defects, which develop in the first few weeks.

Want to Apply This Research?

  • Track daily folic acid supplement intake (yes/no) and note any seizure medication changes. Users can log their folate supplement dose and timing to ensure consistency. If the app has access to lab results, users can record folate level test results and dates to monitor trends over time.
  • Set a daily reminder to take folic acid supplements at the same time each day. Create a pre-pregnancy checklist that includes scheduling a doctor visit to discuss folate status and seizure medications. Log conversations with healthcare providers about folate needs to maintain accountability.
  • Monthly check-ins on supplement adherence; quarterly reminders to discuss folate levels with doctor; annual review of folate status through lab work if planning pregnancy. The app could flag when it’s time for follow-up appointments and provide educational reminders about why folate matters for women with epilepsy.

This review summarizes research findings but is not medical advice. Women with epilepsy should consult their neurologist and obstetrician before making changes to medications or supplements, as seizure control during pregnancy is critical. Folic acid supplementation needs should be individualized based on personal medical history, current medications, and folate levels. This information is for educational purposes and does not replace professional medical guidance. If you are pregnant or planning pregnancy, work with your healthcare team to develop a personalized plan that addresses both epilepsy management and folate adequacy.