A 28-year-old woman at 9 weeks of pregnancy takes sodium valproate for epilepsy and has not been taking folic acid. What is the most appropriate advice about folic acid?
Answer and explanation
Correct answer: B. Take 5 mg daily until the end of the first trimester
- Step 1: Antiepileptic drugs and neural tube defect risk call for the higher dose.
- Step 2: NICE and the NHS advise 5 mg daily, ideally preconception, until 12 weeks for women on antiepileptics, with diabetes, BMI of 30 or more or previous neural tube defect.
Answer
Take 5 mg daily until the end of the first trimester.
Why not the others: Take 400 micrograms daily and stop at 6 weeks: Stopping at 6 weeks leaves the neural tube vulnerable earlier than closure ends. Folic acid is unnecessary because valproate protects the fetus from neural tube defects: Valproate raises, not lowers, the risk of neural tube defects. Take 400 micrograms daily until the end of the second trimester only: 400 micrograms is the standard dose for low-risk women and she is at higher risk.
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