“Women with epilepsy should be encouraged to breastfeed”

Additional evidence from the MONEAD study supports the choice of breastfeeding by women on anti-seizure medication (ASM). Focusing on some of the newer ASMs, results showed that neurodevelopmental outcomes at the age of 3 did not differ in children of women with epilepsy who breastfed compared with those who did not.

Potential adverse neurodevelopmental effects of ASM exposure via breastfeeding have so far only been directly compared in 2 prior studies that involved mostly older ASMs [1,2]. Prof. Kimford Meador (Stanford Comprehensive Epilepsy Center, CA, USA) presented the results of the ongoing, observational, prospective MONEAD study (NCT01730170) [3].

The study cohort consisted of 258 children whose mothers had used 1 (79%) or more (21%) ASMs during the third trimester of their pregnancy, of whom 195 were breastfed and 63 were not. The most frequently used ASMs were lamotrigine (35%), levetiracetam (28%), or both (10%). The primary outcome was a verbal index score at age 3, calculated by averaging the following scores: Differential Ability Scales-II (DAS-II) Naming Vocabulary and Verbal Comprehension subtests, Preschool Language Scale-5 Expressive Communication and Auditory Comprehension subscales, and Peabody Picture Vocabulary Test-4.

No difference was detected in neurodevelopmental outcomes at age 3. Adjusted verbal index score (least square means) was 103 in children of women with epilepsy and 102 in children of healthy women (P=0.770). Breastfeeding did not have any impact on cognitive outcomes either. The adjusted verbal index score was 103.3 for children of women with epilepsy who were breastfed versus 100.6 for those who were not (P=0.108).

“This is a very positive message for women with epilepsy,” said Prof. Meador. Despite high ASM concentrations in blood samples of breastfeeding women, no high ASM concentrations were observed in blood samples of children who were breastfed, possibly due to the high metabolism rate of infants. This might explain why these children were not affected by ASM use of their mothers. Prof. Meador concluded: “Given the known multiple benefits of breastfeeding for the infant and mother from general population data, women with epilepsy should be encouraged to breastfeed.”

Dr Jennifer Hopp (University of Maryland School of Medicine, MD, USA) commented on the results and told the audience: “Help these women make informed decisions. These results support the choice to breastfeed while using some of the newer ASMs. The next step is yours.” The MONEAD study will continue to follow the children until the age of 6 years.

1. Palac S & Meador KJ. Curr Neurol Neurosci Rep. 2011;11(4):423–427.
2. Wiggs KK, et al. Neurology. 2020;95(24):e3232–40.
3. Meador K, et al. Breastfeeding with antiseizure medications: Effects on neuropsychological outcomes at Age 3 years in the MONEAD Study. Contemporary Clinical Issues, AAN 2022, 02–07 April, Seattle, USA.

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Posted on 2 June, 202213 June, 2022