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pptrv-8067.pdf#3115 3 5 Isotretinoin) reports of sleepiness were not significant, and no significant differences were found between subgroups. Although it may seem obvious to women of childbearing potential to avoid taking drugs with the potential to increase the risk of birth defects, there are other important considerations for women of childbearing potential in choosing a medication. These considerations include the potential for teratogenicity and the availability of alternative treatments with similar or fewer side effects.5 While we are not certain whether the gestational age influenced the differences we found, we have several hypotheses. First, gestational age is a factor in the development of a fetus, but it is unclear how gestational age relates to fetal brain development. One possibility is that risk is more likely to increase with early gestational age in order to compensate for the timing of sensitive brain development, such as the first trimester of pregnancy.16 Another possibility is that increased risk is greatest during the critical period of brain development. Although the IOM has not made a recommendation regarding how early in pregnancy a woman of childbearing potential should take prenatal vitamins, the association of low folic acid levels with increased risk of neural tube defects suggests that the optimal time to take folic acid should be closer to the time of conception.16,17 The IOM has also not determined the appropriate dose of folic acid to take, but the AAP recommends that women of childbearing potential take 400 µg of folic acid daily.17 We therefore chose 400 µg of folic acid daily in our study. As to the timing of the assessment of vitamins, since most women of childbearing potential conceive at 12 to 13 weeks of gestation, the best time to take the test is in early pregnancy.6,16,17 Second, the IOM has determined that the potential for adverse outcomes increases as gestational age increases.1,6,16,17 For example, the IOM has recommended that women who conceive later in pregnancy be given 100% of the recommended dietary allowance (RDA) of vitamin D, which is 600 mg, to prevent vitamin D deficiency.1,6,17 This is because the risk of having a baby with a low vitamin D level is greatest when the woman conceives later in her pregnancy.6,16,17 Fourth, our results are based on oral contraceptives and other medications that may be prescribed to reduce the risk of neural tube defects. This is because the medications tested in this study are

 

 


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