Abstracts

Rationale: Low folate levels in early pregnancy can adversely affect neuropsychological outcomes, but some studies suggest that high doses of folic acid may adversely affect neuropsychological outcomes. In the general population, maternal red blood cell (RBC) folate concentrations >906 nmol/L ( >400 ng/mL) have been noted to protect against folic acid-related neural tube defects, but the relationship of RBC folate levels to neuropsychological outcomes is not clear. Further, some antiseizure medications (ASMs) can affect folate, and supplementation of folate in early pregnancy improves neuropsychological outcomes in children of women taking ASMs. However, the best protective RBC folate level in women taking ASMs is unknown. Here, we examine this relationship in the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study.

Methods: The MONEAD study is a prospective, observational, multi-center, NIH-funded investigation of pregnancy outcomes which enrolled women with epilepsy (WWE) and healthy women (HW) during pregnancy. Our a priori main cognitive outcome was blindly-assessed 6 year-old (yo) Verbal Index score (average of standardized language measures). The main behavioral outcome was the Adaptive Behavior Assessment System-3rd ed - General Adaptive Composite (ABAS-GAC). Maternal RBC folate was measured by a central laboratory. Adjusted linear regression models (based on prior age 6yo analyses) assessed associations of Verbal Index and ABAS-GAC scores to maternal RBC folate levels in early pregnancy (<