Impact of Maternal Folate Status on Child's Autistic Traits After AED Exposure
A study published in JAMA Neurology reported that children exposed to antiepileptic drugs (AEDs) in utero may have a reduced risk of autistic traits with periconceptional folic acid supplementation and folate status.
Researchers from Norway aimed to evaluate whether folic acid supplementation and folate status in pregnancy were linked to a lower risk of autistic traits following AED exposure in utero. The Norwegian Mother and Child Cohort Study, a population-based, prospective trial, involved questionnaires of women during and after pregnancy, analysis of blood samples, and linkage to the Medical Birth Registry of Norway. The analysis (March 1, 2016 to June 13, 2017) included children aged 18–36 months of women with data on use of AEDs and folic acid supplementation (N=104,946); complete information was available for analysis in 103,868 mothers.
The authors evaluated for autistic traits using the Modified Checklist for Autism in Toddlers and Social Communication Questionnaire. Maternal folic acid supplementation included use 4 weeks before to 12 weeks post-conception; plasma folate concentration was assessed at gestational weeks 17 through 19.
The data showed of the 335 children exposed to AEDs, the risk for autistic traits was significantly greater at 18 months of age (adjusted odds ratio [aOR] 5.9, 95% CI: 2.2–15.8) and at 36 months of age (aOR 7.9, 95% CI: 2.5–24.9) when mothers did not use folic acid supplements vs children of mothers that did use supplements.
For women without epilepsy, the risks of autistic traits in children were lower at 18 months (aOR 1.3, 95% CI: 1.2–1.4) and at 36 months (aOR 1.7, 95% CI: 1.5–1.9). In addition, the corresponding risks for children of women with untreated epilepsy (n=389) were not significant at 18 months (aOR 1.0) and 36 months (aOR 2.5).
In regards to maternal plasma folate concentrations and folic acid doses, the extent of autistic traits was inversely associated. Moreover, the concentration of AEDs were not associated with the severity of autistic traits.
Based on the findings, the authors conclude, "Fertile women using AEDs should take folic acid supplements continuously."
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