The knowledge that folic acid can reduce the incidence of neural tube defects has made supplementation with the B vitamin commonplace among women who either are pregnant or capable of becoming so. A new study,1 published in the Journal of the American Medical Association (JAMA) Neurology, now suggests a possible link between maternal folic acid supplementation and lower risk of autistic traits in children exposed to antiepileptic drugs (AED) in utero.
As part of the ongoing long-term prospective Norwegian Mother & Child Cohort Study (MoBa), children aged 18 to 36 months of 104,946 women with available information on AED use and folic acid supplementation were included in an analysis from March 1, 2016, through June 13, 2017. Researchers analyzed the mothers’ plasma folate concentrations at 17 to 19 weeks of gestation and evaluated the children’s autistic traits using the Modified Checklist for Autism in Toddlers and Social Communications Questionnaire.
After adjusting for maternal health and socioeconomic factors, the researchers found that in 335 children exposed to AEDs in utero, the risk for autistic traits (adjusted odds ratio, or AOR) was significantly higher at 18 and 36 months when mothers had not supplemented with folic acid relative to those who did. Among children with mothers without epilepsy, the AOR was lower at both 18 and 36 months, while in the 389 children of epileptic women not treating with AEDs, the corresponding risks were not significant at 18 or 36 months.
The researchers also found an inverse relationship between the degree of children’s autistic traits and their mothers’ plasma folate concentrations and folic acid doses. Plasma concentration of AEDs, however, bore no relation to children’s degree of autistic traits.
Responding to the study in a press statement, Andrea Wong, PhD, vice president, scientific & regulatory affairs, Council for Responsible Nutrition (CRN; Washington, DC), noted that while we already knew folic acid’s role vis-à-vis neural tube defects, “this new study demonstrates the potential for additional benefits of continuous folic acid supplementation.” Acknowledging the researchers’ focus on a specific population of women—those taking AEDs—she maintained that their conclusion “underscores the importance for all women capable of becoming pregnant to supplement with folic acid, too.”
Further, the study points to the need for patients to inform their doctors of their supplement and medication regimes, as the results show that some pharmaceuticals “can create nutrient depletions or side effects (as in this study) that can be mitigated or offset with careful use of dietary supplements,” Wong says.
The U.S. government, American College of Obstetricians and Gynecologists, American Academy of Family Physicians, and American Academy of Pediatrics all recommend that women of childbearing supplement with folic acid.
- Bjørk M, et al., “Association of folic acid supplementation during pregnancy with the risk of autistic traits in children exposed to antiepileptic drugs in utero.” JAMA Neurology. Published online ahead of print, December 26, 2017.