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Folic Acid Blockers May Increase Risk of Birth Defects

Last Updated: October 14, 2009.

Drugs such as methotrexate and anti-epileptics that reduce folic acid levels during the first trimester of pregnancy more than double the risk of congenital abnormalities in the developing fetus, according to a study published online Oct. 14 in the British Journal of Clinical Pharmacology.

WEDNESDAY, Oct. 14 (HealthDay News) -- Drugs such as methotrexate and anti-epileptics that reduce folic acid levels during the first trimester of pregnancy more than double the risk of congenital abnormalities in the developing fetus, according to a study published online Oct. 14 in the British Journal of Clinical Pharmacology.

Ilan Matok, of the Ben Gurion University of the Negev in Be'er-Sheva, Israel, and colleagues analyzed data from 84,823 infants and 998 therapeutically aborted fetuses to assess the safety of folic acid antagonists during the first trimester of pregnancy (13 weeks or less).

The researchers found that 571 infants and fetuses were exposed to at least one folic acid antagonist. There was a higher risk of congenital malformations in exposed infants and fetuses (14.5 versus 6.2 percent; adjusted odds ratio, 2.43), in particular neural tube defects (adjusted odds ratio, 6.30) and cardiovascular defects (adjusted odds ratio, 1.76). Dihydrofolate reductase inhibitors increased the risk of urinary tract defects (adjusted odds ratio, 3.05). Folic acid antagonists did not affect the risk of premature delivery, mortality, low Apgar scores, or low birth weight.

"First trimester exposure to folic acid antagonists is associated with increased risk of congenital malformations," Matok and colleagues conclude. "Clinicians should try to avoid the use of these drugs in women contemplating pregnancy."

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