Cancer Risk in Children of Mothers With Epilepsy and High-Dose Folic Acid Use During Pregnancy

• DOI: 10.1001/jamaneurol.2022.2977
• Publication Date: 2022-09-26T15:31:39Z
• Authors: Håkon Magne Vegrim; Julie Werenberg D...; Silje Alvestad; Nils Erik Gilhus; Mika Gissler; Jannicke Igland; Maarit K. Leinonen; Torbjörn Tomson; Yuelian Sun; Helga Zoega; Jakob Christensen; Marte-Helene Bjørk
• Keywords: Cumulative incidence

Women with epilepsy are recommended high doses of folic acid before and during pregnancy owing to risk congenital anomalies associated antiseizure medications. Whether prenatal exposure high-dose is increases in the childhood cancer unknown.To assess whether supplementation mothers cancer.Observational cohort study conducted nationwide registers Denmark, Norway, Sweden from 1997 2017. Analyses were performed January 10, 2022, 31, 2022. Mother-child pairs identified medical birth linked information patient, prescription, registers, as well sociodemographic statistical agencies, categorized by maternal diagnosis epilepsy. The population consisted 3 379 171 children after exclusion 126 711 because stillbirth or missing erroneous values on important covariates.Maternal prescription fills for tablets (≥1 mg daily) between 90 days start birth.First onset at younger than 20 years. Cox proportional hazards models used calculate adjusted hazard ratios corresponding 95% CIs, potential confounders. Cumulative incidence aged years was a measure absolute risk.The median age end follow-up 7.3 (IQR, 3.5-10.9 years). Among 27 784 (51.4% male) born epilepsy, 5934 (21.4%) exposed (mean dose, 4.3 mg), 18 cases compared 29 unexposed, producing an ratio 2.7 (95% CI, 1.2-6.3), if 1.4% 0.5%-3.6%), unexposed 0.6% 0.3%-1.1%). In without 46 646 (1.4%) 2.9 69 4927 1.1 0.9-1.4; risk, 0.4% [95% 0.3%-0.5%]). There no association who prenatally medications, but not acid, increased (absolute 0.6%; 0.2%-1.3%).Prenatal