Breastfeeding During Antiseizure Medication Use Not Linked to Adverse Neurodevelopmental Outcomes: Study

Published in JAMA Network Open, the prospective cohort study examined children born to women with epilepsy (WWE) who were taking contemporary ASMs, primarily levetiracetam and lamotrigine. The researchers used data from the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study, which followed children from pregnancy through 6 years of age.

The analysis included 273 children born to women with epilepsy and 84 children born to healthy women. For language outcomes, data were available for 262 children in the epilepsy group and 80 in the healthy group, while behavioral outcomes were assessed in 261 and 83 children, respectively.

The researchers assessed whether breastfeeding duration — no breastfeeding, less than 6 months, or 6 months or longer — was associated with children's verbal language and adaptive behavior at age 6 years.

The findings were:

• Verbal language outcomes at age 6 years were comparable between children born to women with epilepsy and those born to healthy women.
• Adaptive behavioral scores were also similar between the two groups, with no significant overall differences.
• Among children born to women with epilepsy, breastfeeding for 6 months or longer was associated with a 4.68-point higher adaptive behavior score compared with no breastfeeding.
• The improvement was mainly observed in the practical and conceptual adaptive behavior domains.
• Children breastfed for less than 6 months did not show a significant difference in adaptive behavior compared with those who were not breastfed.
• Neurodevelopmental outcomes remained comparable across specific ASM regimens, including levetiracetam, lamotrigine, other monotherapies and polytherapy, regardless of breastfeeding duration.
• The association between breastfeeding for at least 6 months and improved adaptive behavior remained significant among children whose mothers received ASM monotherapy, but not among those exposed to polytherapy.

Concerns about infant exposure to ASMs through breast milk may discourage breastfeeding among women with epilepsy. This study provides long-term neurodevelopmental data up to age 6 years, although residual confounding, small medication-specific subgroups, lack of breastfeeding exclusivity data and recruitment from specialized epilepsy centers limit the findings.

Overall, breastfeeding while taking contemporary ASMs was not associated with adverse cognitive or behavioral outcomes at age 6 years. Breastfeeding for at least 6 months was associated with better adaptive behavior, supporting continued breastfeeding when clinically appropriate.