Authors :
Nanya Hao, PhD – West China Hospital, Sichuan University
Presenting Author: Ammar T. Abdulaziz, PhD – West China Hospital, Sichuan University
Yujie Chen, BS – West China Hospital, Sichuan University
Tao Li, MD – West China Second Hospital, Sichuan University
Jie Liu, MD – Sichuan People's Hospital
Xu Lin, MD – 363 Hospital
Xiaoting Hao, MD – West China Hospital, Sichuan University
Jinmei Li, MD – West China Hospital, Sichuan University
Xintong Wu, MD – West China Hospital, Sichuan University
Dong Zhou, MD – West China Hospital, Sichuan University
Rationale:
This study aims to determine the prevalence and predictors of folic acid intake, as well as explore the prescription patterns and changes in practice over a decade in all women with epilepsy enrolled in the West China Registry of Epilepsy.Methods:
All pregnancies of women with epilepsy between 2012 and 2021 were analyzed for the pre-, post-, and peri-conceptional use of folic acid. The timing, dosing, and duration of folic acid were assessed and compared among the groups. The changes in folic acid prescription practice and its associated predictors were identified and reported.
Results:
1638 pregnancies in 1405 women with epilepsy met the inclusion criteria and were enrolled in this study. Overall, folic acid was used by 1299 (79.3%) pregnancies periconceptionally. The proportion of pregnancies on folic acid supplements has increased from 55.7% to 85.1% over a decade. Predictors of folic acid use were planned pregnancy, GTC seizures, no ASMs/ polytherapy, advanced level of education, longer epilepsy duration, and better socioeconomic status. Folic acid was used before conception in 512 (31.3%) and after conception in 787 (48%) pregnancies. Low-dose folic acid (≤0.4mg) was used in 821 (50.1%), medium dose (0.5mg to 0.99mg) in 213 (13%), and high-dose (≥1mg) in 265 (16.2%) pregnancies. Folic acid was used for less than 3 months in 514 (31.4%), 3 - 6 months in 351 (21.4%), and more than 6 months in 434 (26.5) pregnancies of women with epilepsy. The proportion of pregnancies on at least 3-month folic acid supplements has dramatically increased from 19% to 58% over the 10-year study period. Unexpectedly, pregnancies on older ASMs (PB, PTH, VPA, CBZ) and TPM were significantly less likely to use folic acid supplements than those on the newer ASMs (LEV, OXC, and LTG).Conclusions:
This study has enabled us to observe the shift in prescription patterns of folic acid supplements in women with epilepsy. It is reassuring to notice that folic acid is increasingly being used during periconception; however, low-dose folic supplementation has remained the most popular prescription. Furthermore, there are growing trends towards early initiation and longer duration of folic acid prescriptions in women with epilepsy.Funding: We have been founded by the National Natural Science Foundation of China (No. 81901327, 81871017, and U21A20393), the Science and Technology Support Program of Sichuan Province (No. 2019YFH0196 and 2023YFQ0109), the 1.3.5 project for disciplines of excellence and Brain Science project of West China Hospital, Sichuan University (ZYJC21001), the 1.3.5 Talent Excellence Development Project - West China Hospital of Sichuan University(ZYGD20011 ,ZYGD22003 ), the West China Nursing Discipline Development Special Fund Project, Sichuan University (HXHL20004), the National Key R&D Program of China (2021YFC2401201), and Natural Science Foundation of Sichuan (2022NSFSC1488) to explore the risks of ASMs in utero exposure and its underlining mechanisms.