Initiation and Duration of Breastfeeding in the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs Study

Abstract

Background and Objectives: Breastfeeding has important health benefits for both mother and child. We characterize breastfeeding initiation and duration in mothers with epilepsy relative to control mothers in a large prospective cohort. Methods: The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is a prospective, multi-center observational, US cohort study. Pregnant subjects with and without epilepsy, aged 14-45, were enrolled 12/19/12 to 2/11/16. Exclusion criteria included IQ <70, and gestational age >20 weeks at enrollment. Breastfeeding assessed via electronic diary and at study visits until 2 years postpartum. Odds of initiating breastfeeding was compared between groups using unadjusted and adjusted logistic regression models. Duration of breastfeeding was compared between groups using the log-rank test. Results: 351 pregnant subjects with epilepsy and 105 pregnant controls enrolled. Breastfeeding data available for 325 mothers with epilepsy and 98 controls. Study groups were similar demographically except race (P=0.008); 84.9% of mothers with epilepsy and 71.4% of controls were white. Mean IQ was lower in mothers with epilepsy compared with controls (97.7 vs. 104.2, P<0.001). Breastfeeding was initiated by 74.8% mothers with epilepsy and 88.8% controls; this difference was significant in unadjusted logistic regression [Odds Ratio (OR) 0.4 (95% CI 0.2,0.7), P=0.004)], but not in adjusted model [OR 0.5 (95% CI 0.2,1.0), P=0.051)]. Factors associated with breastfeeding were higher maternal education and IQ. There was no difference in duration of breastfeeding between mothers with and without epilepsy [median duration 8.5 months vs. 9.9 months, P=0.793)]. Among mothers with epilepsy, both convulsive seizures and all seizures that impair awareness during pregnancy were associated with lower breastfeeding initiation [OR 0.4 (95% CI 0.2,0.8), P=0.013) and OR 0.4 (95% CI 0.2,0.8), (P=0.003) respectively]. Any peripartum seizures were associated with shorter breastfeeding duration [median 6 months vs. 9.7 months, (P=0.040)]. Discussion: Mothers with epilepsy were less likely to initiate breastfeeding compared to controls, however this difference was not significant when controlling for maternal IQ and education level. Continuation of breastfeeding once initiated was not different between mothers with and without epilepsy. Seizure control was associated with breastfeeding initiation and duration in mothers with epilepsy.

Breastfeeding while on treatment with antiseizure medications: a systematic review from the ILAE Women Task Force

“…Three cases of sedation were reported among 16 children breastfed by mothers taking levetiracetam, which resolved shortly after switching to partial breastfeeding [45]. A large prospective study, of which 84 breastfeeding women were on levetiracetam, did not show overall adverse effects at age two years across all ASMs [46].…”

“…Prospective long‐term follow‐up studies of developmental outcomes among children that have been breastfed by mothers taking ASMs are sparse [15-17, 46], and have mainly involved children whose mothers were taking carbamazepine, lamotrigine, levetiracetam, phenytoin or valproate while breastfeeding. None of these studies indicated poorer outcome among breastfed children compared with those who were not breastfed [15-17, 46]. In fact, among children of mothers treated with valproate, IQ at six years of age was higher in those who had been breastfed compared to those who had not [16].…”