Abdulaziz, Ammar T; Hao, Nanya; O'Brien, Terence J; Sander, Josemir W; Li, Jinmei; Zhou, Dong; (2025) Folate deficiency in women with epilepsy: a scoping review. Brain , 148 (11) pp. 3801-3816. 10.1093/brain/awaf298.

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Abstract

Folate deficiency is associated with increased risks of adverse maternal and offspring health outcomes. This review aimed to review the available evidence on folate deficiency among women with epilepsy, particularly potential causes and identified predictors of inadequate folic acid (FA) supplement use. We conducted this review using the PRISMA extension for scoping reviews. We searched Medline, Embase, EBM reviews and all Ovid journals for studies reporting on folate status/FA use in women with epilepsy. Of 3778 items reviewed, 105 relevant articles were identified and included. Many reports suggest that folate deficiency is common among women with epilepsy. Common triggers for folate deficiency include poor dietary intake, inadequate FA use, genetic susceptibility, poor fortification policies, antiseizure medications, increased demands, chronic inflammation, lifestyle factors and lack of counselling. The prevalence of FA use among women with epilepsy is low, with more than half not taking supplements before conception. Predictors of inadequate FA use are unplanned pregnancy, low educational achievement, low socio-economic status, being part of an ethnic minority, lack of counselling, young age, no antiseizure medication exposure and concerns about its use. Current practice needs adjustments towards establishing an adequate, rather than minimal, folate concentration in women with epilepsy to prevent adverse outcomes. One-size-fits-all seems inappropriate; folate intake should be individualized and adjusted to achieve adequate folate status based on folate levels and other metabolic biomarkers. Folate deficiency in women with epilepsy may reflect disparities in care and links to several social determinants of health. Despite the potential progress recently achieved in understanding folate deficiency in women with epilepsy, there are still significant gaps in knowledge requiring further work. Folate deficiency is common among women with epilepsy. The causes of folate deficiency are multifactorial, and awareness, early recognition, proper intervention and regular follow-ups are required to maintain adequate folate levels. Establishing an adequate, rather than minimal, folate concentration to prevent adverse outcomes is imperative. More work is needed to understand the mechanisms of folate deficiency in women with epilepsy and to develop the optimal intervention strategies.

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