Can Women Who Take Seizure Drugs Breastfeed?

A new study offers promising data for women with epilepsy. Breastfeeding infants while taking seizure medications may have no harmful effect on the child’s IQ later in life, according to research published in Neurology.

“While more research is needed with larger numbers of women and their babies, these results are reassuring to women who want to give their babies all the benefits of breastfeeding but also need to remain on their epilepsy medications to avoid devastating seizures,” said study author Kimford Meador, MD, of Emory University in Atlanta, GA.

As part of the Neurodevelopmental Effects of Antiepileptic Drugs Study, an ongoing prospective multicenter observational investigation of long-term effects of in utero antiepileptic drug (AED) exposure on cognition, the study followed 194 pregnant women who were taking a single AED (carbamazepine, lamotrigine, phenytoin, or valproate), focusing specifically on the effects of breastfeeding during AED therapy on cognitive outcomes. Of the 199 babies, 42% were breastfed. Children were administered IQ tests at age three.

Although the authors noted that more research is needed on the effects of other, newer drugs for epilepsy, they did find that there was no difference in IQ scores between the children who were breastfed and those who were not (those who were breastfed scored 99 on the test, while those who were not scored 98, which is not a significant difference, they said). Children whose mothers were taking valproate had lower IQ scores, whether or not they were breastfed.

American Academy of Neurology guidelines recommend that valproate be avoided during pregnancy due to risks of birth defects and effects on cognitive skills. It is also recommended that women avoid taking more than one epilepsy drug at a time during pregnancy, since taking more than one drug has been found to increase the risk of birth defects compared to taking only one medication.

Editorial author Autumn Klein, MD, PhD, of Brigham and Women’s Hospital and the Harvard Medical School in Boston said that this is one of the first large studies on breastfeeding while taking an epilepsy drug.

“Many women are counseled not to breastfeed due to the lack of information on the effects of these drugs, but breastfeeding has many positive emotional effects for the mother and the baby along with the decreased risks for heart disease, diabetes, and obesity in the child and breast and ovarian cancer in the mother,” Klein said in a statement. “This study highlights the pressing need for more data on epilepsy drugs in breast milk and the long-term effects.”

To read the Neurology study, click here.

In your practice, do you recommend that women who are taking antiepileptic drugs avoid breastfeeding?