Folic acid is frequently given to women of childbearing age who are taking antiepileptic drugs. During pregnancy, the dose of folic acid is often increased, depending on whether the woman is on an inducer medication. Dosing can vary between 1 and 4 mg of folic acid daily. Studies have suggested no benefit at a higher dose. Is there a recommended dose of folic acid in general and/or during pregnancy at this time?—SHARI COMBE, MPAS, PA-C, Salt Lake City

Folic acid supplementation at least one month prior to conception and during early pregnancy is recommended to reduce the incidence of neural tubal defects (NTDs). For most women, the recommended daily dosage of folic acid is 400 µg to 800 µg; a higher dosage is advised for women with such risk factors as a history of a child with a NTD, pregestational diabetes, and use of certain antiepileptic drugs (i.e., valproic acid [Depakene, Depakote, Stavzor] and carbamazepine) that have been shown to decrease the concentration of folate. Although there are insufficient data to support a particular recommended dosage of folic acid in women on one of these epileptic medications, the American Congress of Obstetricians and Gynecologists recommends that all women at-risk for having a child with an NTD take 4 mg of folic acid per day. Until further notice, this recommendation seems to be a safe and reasonable option.—Mary Newberry, CNM, MSN (183-2)

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