Breastfeeding and Antiseizure Medications: Neurodevelopment at Age 6
⚠️ Pregnancy-related topic: medication, diet, and testing decisions must be made with your obstetrician and neurology team.
⚠️ Infant dosing/safety: medication and diet decisions for infants require individualized medical guidance.
This explainer reviews breastfeeding and antiseizure medications in a six-year prospective cohort study.
Source: JAMA network open
Summary
What was studied
This prospective, multicenter cohort study followed children to age 6. It included 273 children born to women with epilepsy and 84 children born to healthy women. The pregnant participants enrolled from 2012 to 2016.
Researchers compared no breastfeeding, breastfeeding for less than 6 months, and breastfeeding for at least 6 months. Antiseizure medication exposure primarily involved levetiracetam or lamotrigine. At age 6, researchers assessed verbal language and adaptive behavior, which includes skills used in everyday life.
What they found
Children born to women with epilepsy had verbal language and adaptive behavior scores that did not significantly differ from those of children born to healthy women. Breastfeeding while taking the studied antiseizure medications was not associated with adverse neurodevelopmental outcomes at age 6.
Among children of women with epilepsy, breastfeeding for at least 6 months was associated with an adaptive behavior score about 4.7 points higher than no breastfeeding. Breastfeeding for less than 6 months did not significantly differ from no breastfeeding. The association remained significant in the pooled monotherapy group but not in the polytherapy group. Within each specific medication regimen studied, neurodevelopmental outcomes were comparable regardless of breastfeeding duration.
Limits of the evidence
This was an observational cohort study, so it cannot establish that breastfeeding caused better adaptive behavior. The study primarily involved levetiracetam and lamotrigine, so its findings may not apply equally to every antiseizure medication regimen.
For families and caregivers
These findings are reassuring: breastfeeding while taking the contemporary antiseizure medication regimens studied was not associated with poorer language or adaptive functioning at age 6. Breastfeeding for at least 6 months was also associated with higher adaptive behavior scores, but the study does not prove that breastfeeding caused this difference or address every possible medication regimen.
What to watch next
Further research can examine breastfeeding outcomes with additional specific antiseizure medications and medication combinations. Families can discuss breastfeeding plans and their individual medication regimen with their neurology and maternity teams.
Terms in this summary
- Antiseizure medication
- A medicine used to prevent or reduce seizures.
- Adaptive behavior
- Everyday practical, social, and communication skills used to function independently.
- Monotherapy
- Treatment with one antiseizure medication.
- Polytherapy
- Treatment with more than one antiseizure medication.
- Cohort study
- A study that follows groups of people over time and compares their outcomes.
- Association
- A statistical link between two factors that does not by itself show that one caused the other.
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