Periconceptional folic acid supplementation for women with epilepsy: A systematic review of the literature

IF 2.3 3区医学 Q2 BEHAVIORAL SCIENCES

Epilepsy & Behavior Pub Date : 2024-09-25 DOI:10.1016/j.yebeh.2024.110064

{"title":"Periconceptional folic acid supplementation for women with epilepsy: A systematic review of the literature","authors":"","doi":"10.1016/j.yebeh.2024.110064","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate whether folic acid supplementation at normal or high doses could reduce major congenital malformations and improve neurodevelopment in the offspring of women with epilepsy (WWE).</div></div><div><h3>Methods</h3><div>The MEDLINE, EMBASE, Web of Science, Cochrane Library, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> databases were searched for observational studies reporting pregnancy outcomes and information about folic acid supplementation in WWE, with a cut-off date of December 5, 2023. Data extraction and synthesis were performed in accordance with the PRISMA guidelines. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. A random-effects <em>meta</em>-analysis was conducted to obtain pooled odds ratios (ORs) and 95% confidence intervals (CI), to estimate the effect of periconceptional folic acid supplementation on pregnancy outcomes in WWE. Sensitivity analyses including only studies with WWE who took anti-seizure medications during pregnancy or studies with a sample size greater than 100 were further performed. This study was registered in PROSPEROID (no. CRD42019141820).</div></div><div><h3>Results</h3><div>The database search yielded 23 eligible articles. Unexpectedly, the results of subsequent <em>meta</em>-analysis showed that the risk of major congenital malformations was relatively higher in those with periconceptional folic acid supplementation (17463 pregnancies, OR, 1.34; 95 %CI, 1.12–1.6), and was similar between those with and without folic acid supplementation ≧ 4 mg (3822 pregnancies, OR, 0.9; 95 %CI, 0.65–1.24). Results showed that periconceptional folic acid supplementation may be beneficial for neurodevelopment but the evidence was limited.</div></div><div><h3>Conclusions</h3><div>This systematic review showed no evidence of a beneficial effect of folic acid supplementation in reducing the risk of major congenital malformations, while the relative risk was slightly higher in those receiving periconceptional folic acid supplementation. Nevertheless, folic acid supplementation may improve neurobehavioral outcomes.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Epilepsy & Behavior","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1525505024004463","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"BEHAVIORAL SCIENCES","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

This study aimed to investigate whether folic acid supplementation at normal or high doses could reduce major congenital malformations and improve neurodevelopment in the offspring of women with epilepsy (WWE).

Methods

The MEDLINE, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov databases were searched for observational studies reporting pregnancy outcomes and information about folic acid supplementation in WWE, with a cut-off date of December 5, 2023. Data extraction and synthesis were performed in accordance with the PRISMA guidelines. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. A random-effects meta-analysis was conducted to obtain pooled odds ratios (ORs) and 95% confidence intervals (CI), to estimate the effect of periconceptional folic acid supplementation on pregnancy outcomes in WWE. Sensitivity analyses including only studies with WWE who took anti-seizure medications during pregnancy or studies with a sample size greater than 100 were further performed. This study was registered in PROSPEROID (no. CRD42019141820).

Results

The database search yielded 23 eligible articles. Unexpectedly, the results of subsequent meta-analysis showed that the risk of major congenital malformations was relatively higher in those with periconceptional folic acid supplementation (17463 pregnancies, OR, 1.34; 95 %CI, 1.12–1.6), and was similar between those with and without folic acid supplementation ≧ 4 mg (3822 pregnancies, OR, 0.9; 95 %CI, 0.65–1.24). Results showed that periconceptional folic acid supplementation may be beneficial for neurodevelopment but the evidence was limited.

Conclusions

This systematic review showed no evidence of a beneficial effect of folic acid supplementation in reducing the risk of major congenital malformations, while the relative risk was slightly higher in those receiving periconceptional folic acid supplementation. Nevertheless, folic acid supplementation may improve neurobehavioral outcomes.

查看原文本刊更多论文

癫痫妇女围产期叶酸补充：文献系统回顾

方法在MEDLINE、EMBASE、Web of Science、Cochrane Library和ClinicalTrials.gov数据库中检索报告妊娠结局的观察性研究以及有关WWE叶酸补充的信息，截止日期为2023年12月5日。数据提取和综合按照 PRISMA 指南进行。研究的方法学质量采用纽卡斯尔-渥太华量表进行评估。采用随机效应荟萃分析法得出汇总的几率比（ORs）和95%置信区间（CI），以估计围孕期补充叶酸对WWE妊娠结局的影响。敏感性分析仅包括孕期服用抗癫痫药物的 WWE 或样本量大于 100 的研究。本研究已在 PROSPEROID（编号：CRD42019141820）上注册。意外的是，随后的荟萃分析结果显示，围孕期补充叶酸的孕妇发生重大先天性畸形的风险相对较高（17463 例妊娠，OR，1.34；95 %CI，1.12-1.6），而叶酸补充量大于 4 mg 的孕妇和未补充叶酸的孕妇发生重大先天性畸形的风险相似（3822 例妊娠，OR，0.9；95 %CI，0.65-1.24）。结果表明，围孕期补充叶酸可能对神经发育有益，但证据有限。结论该系统综述显示，没有证据表明补充叶酸对降低重大先天性畸形的风险有益，而围孕期补充叶酸的孕妇相对风险略高。不过，补充叶酸可能会改善神经行为的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Epilepsy & Behavior 医学-行为科学

CiteScore

5.40

自引率

15.40%

发文量

385

审稿时长

43 days

期刊介绍： Epilepsy & Behavior is the fastest-growing international journal uniquely devoted to the rapid dissemination of the most current information available on the behavioral aspects of seizures and epilepsy. Epilepsy & Behavior presents original peer-reviewed articles based on laboratory and clinical research. Topics are drawn from a variety of fields, including clinical neurology, neurosurgery, neuropsychiatry, neuropsychology, neurophysiology, neuropharmacology, and neuroimaging. From September 2012 Epilepsy & Behavior stopped accepting Case Reports for publication in the journal. From this date authors who submit to Epilepsy & Behavior will be offered a transfer or asked to resubmit their Case Reports to its new sister journal, Epilepsy & Behavior Case Reports.