Review Question - QID 103108

Folic acid supplementation is recommended during preconception and the first trimester of pregnancy to reduce the risk of neural tube defects, including spina bifida and anencephaly. Neural tube defects are particularly concerning in patients taking antiepileptics given the possible anti-folate properties of these medications.

Folic acid supplementation in the preconception and/or early pregnancy period reduces the incidence of neural tube defects significantly. For this reason, pregnant patients are generally recommended to supplement folate when they are pregnant or are trying to become pregnant. Antiepileptic drugs, in particular, increase the risk of neural tube defects. For this reason, it is generally recommended that women who must take antiepileptics during pregnancy also take high doses of folate.

Incorrect Answers:
Answer 2: Iron is usually supplemented in pregnancy given that there is an increased need for red blood cell production.

Answer 3: Magnesium is the treatment of acute seizures in preeclampsia/eclampsia/HELLP syndrome but is not indicated as prophylaxis for an underlying seizure condition.

Answer 4: Vitamin B12 is indicated in vitamin B12 deficiency which presents with megaloblastic anemia and signs of dorsal column dysfunction such as ataxia and abnormal proprioception.

Answer 5: Vitamin D is appropriate to supplement in pregnancy and leads to appropriate bone development and serum calcium levels; however, it is less dire than folate supplementation in pregnant patients taking antiepileptics.

Bullet Summary:
Folate is recommended in pregnancy to reduce the incidence of neural tube defects, especially when taking antiepileptics such as carbamazepine.