Dr. Chapa’s OBGYN Clinical Pearls Folic Acid Update: Women on Epilepsy Meds Do NOT Need More
Nov 2, 2025
Discover the latest updates on folic acid recommendations for women on anti-seizure medications. High doses are no longer the standard, shifting from 4-5 mg to a safer range of 400-800 mcg. Dr. Chapa highlights research suggesting that additional folate may not reduce risks for neural tube defects linked to certain epilepsy drugs. International guidelines are changing too, as countries adopt lower dosing. Tune in for crucial insights that impact clinical practices and patient care during pregnancy.
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High-Dose Folic Acid Recommendation Changed
- High-dose folic acid (4–5 mg) for people on antiseizure meds is no longer routinely recommended.
- Recent evidence and guidelines suggest standard 400–800 µg dosing is adequate and safer.
Use Standard Doses Unless Specific Risk Exists
- Give 400–800 micrograms folic acid to people with epilepsy who may become pregnant unless other risk factors exist.
- Reserve higher doses only for multifetal gestation (1,000 µg) or previous neural tube defect (4,000 µg).
Older Seizure Drugs Still Exist
- Dr. Chapa notes few reproductive-age women still use older drugs like valproate or carbamazepine.
- He explains those older drugs historically linked to higher neural tube defect risk.
