Folic Acid Update: Women on Epilepsy Meds Do NOT Need More

Taking folic acid prior to conception and during pregnancy can help protect the unborn baby from developing abnormalities. Supplements are particularly important for women who have epilepsy, as anti-seizure medication (previously known as anti-convulsants or anti-epileptic drugs) can lead to a deficiency in folic acid. Until 2023, high doses of 4-5 mg per day were recommended. However, this has changed as the data has changed. Did you know the SMFM no longer recommends “high dose” folic acid preconceptionally for patients on seizure medications? This is also highlighted in a recently released epub from Obstetrics and Gynecology (Green Journal) on October 31, 2025. Listen in for details.

1. Mokashi, Mugdha MD, MPH; Cozzi-Glaser, Gabriella MD; Kominiarek, Michelle A. MD, MS. Dietary Supplements in the Perinatal Period. Obstetrics & Gynecology ():10.1097/AOG.0000000000006098, October 31, 2025. | DOI: 10.1097/AOG.0000000000006098

2. Asadi-Pooya AA. High dose folic acid supplementation in women with epilepsy: are we sure it is safe? Seizure. 2015 Apr;27:51-3. doi: 10.1016/j.seizure.2015.02.030. Epub 2015 Mar 7. PMID: 25891927.

3. https://aesnet.org/about/aes-press-room/press-releases/guideline-issued-for-people-with-epilepsy-who-may-become-pregnant

4. Turner C, McIntosh T, Gaffney D, Germaine M, Hogan J, O'Higgins A. A 10-year review of periconceptual folic acid supplementation in women with epilepsy taking antiseizure medications. J Matern Fetal Neonatal Med. 2025 Dec;38(1):2524094. doi: 10.1080/14767058.2025.2524094. Epub 2025 Jun 30. PMID: 40588438.

5. https://www.aan.com/PressRoom/Home/PressRelease/5170#:~:text=The%20guideline%20recommends%20that%20people,and%20possibly%20improve%20neurodevelopmental%20outcomes.

6. https://aesnet.org/about/aes-press-room/press-releases/guideline-issued-for-people-with-epilepsy-who-may-become-pregnant