Reply to Letter to the Editor

Abstract

We read with interest the comments of Dr. Goldman who wished to protect the Materna® including 1 mg of folic acid. We did not blame, however, this multivitamin. Our previous randomized double-blind controlled trial of periconceptional multivitamin supplementation [1] had three purposes: (1) to check the efficacy of the prevention of the first occurrence of neural-tube defects and (2) orofacial clefts, and (3) to reveal any other adverse or beneficial effects of this new preventive method. Among possible adverse effects, two were focused: pernicious anemia and epilepsy. Pernicious anemia did not occur among our participants, however, we had 60 epileptic women. (Dr. Goldman is not right, epileptic women did not take part in the MRC Vitamin Study, because it was an exclusion criterion.) Our experiences were good in all but one epileptic women during periconceptional multivitamin (Elevit Pronatal®) supplementation including 0.8 mg of folic acid in the Hungarian trial: anticonvulsant-related congenital abnormalities or any other hazards were no founds in these pregnant women. The exceptional case indicated that an autoimmune disease as SLE can disturb blood-brain barrier and folic acid (particularly high dose) may be convulsant in this particular case. In conclusion, periconceptional folic acid-containing or folic acid alone supplementation is not contraindicated in epileptic women without autoimmune diseases if the dose of folic acid does not exceed the tolerable upper level of folic acid or folic acid-folate together (the latter is about 0.2 mg daily through diet) i.e. 1 mg [2]. In addition folic acid may diminish the teratogenic risk of some anticonvulsant drugs during pregnancy.