What is advised for women with a history of seizures prior to pregnancy?

For women with a history of seizures prior to pregnancy, it is recommended to start folate supplementation at a higher dose of 4 mg daily. This is primarily due to the increased risk of neural tube defects associated with certain antiepileptic medications used to manage seizures. Folate is crucial for fetal neural development, particularly in the early stages of pregnancy, when the neural tube is forming. The higher dose of folate is advised to mitigate this risk and to ensure that the woman has adequate levels to support a healthy pregnancy.

In contrast to this recommendation, discontinuing all medications may lead to a recurrence of seizures, which poses significant risks to both the mother and the fetus. Similarly, increasing medication dosage could potentially lead to harmful side effects or increased teratogenic risks. Avoiding all supplements is not advisable, particularly when it comes to folate, as it can provide essential support during pregnancy. Hence, initiating a daily regimen of 4 mg of folate is a well-supported and critical strategy for managing the health of women with a history of seizures who are planning to conceive or are already pregnant.