Breast is Still Best: No Harmful Effects of Breastfeeding in Women Taking Antiepileptic Drugs

Abstract

IMPORTANCE: Exposure to antiepileptic drugs during pregnancy is associated with adverse effects on psychomotor development. OBJECTIVES: To determine whether signs of impaired development appear already during the first months of life in children exposed prenatally to antiepileptic drugs, and to explore potential adverse effects of antiepileptic drug exposure through breastfeeding. DESIGN, SETTING, AND PARTICIPANTS: Mothers at 13 to 17 weeks of pregnancy were recruited in the population-based, prospective Norwegian Mother and Child Cohort Study from 1999 to 2009. The mothers reported on their child's motor and social skills, language, and behavior using items from standardized screening tools at 6 months (n = 78,744), 18 months (n = 61,351), and 36 months (n = 44,147) of age. The mothers also provided detailed information on breastfeeding during the first year. MAIN OUTCOMES AND MEASURES: The risk of adverse development in children according to maternal or paternal epilepsy was estimated as the odds ratio with corresponding 95% confidence interval, adjusted for maternal age, parity, education, smoking, breastfeeding, depression/anxiety, folate supplementation, and congenital malformation in the child. RESULTS: At age 6 months, infants of mothers using antiepileptic drugs (n = 223) had a higher risk of impaired fine motor skills compared with the reference group (11.5% vs 4.8%, respectively; odds ratio = 2.1; 95%CI, 1.3-3.2). Use of multiple antiepileptic drugs compared with the reference group was associated with adverse outcome for both fine motor skills (25.0% vs 4.8%, respectively; odds ratio = 4.3; 95%CI, 2.0-9.1) and social skills (22.5% vs 10.2%, respectively; odds ratio = 2.6; 95%CI, 1.2-5.5). Continuous breastfeeding in children of women using antiepileptic drugs was associated with less impaired development at ages 6 and 18 months compared with those with no breastfeeding or breastfeeding for less than 6 months. At 36 months, prenatal antiepileptic drug exposure was associated with adverse development regardless of breastfeeding status during the first year. Children of women with epilepsy who did not use antiepileptic drugs and children of fathers with epilepsy had normal development at 6 months. CONCLUSIONS AND RELEVANCE: Prenatal exposure to antiepileptic drugs was associated with impaired fine motor skills already at age 6 months, especially when the child was exposed to multiple drugs. There were no harmful effects of breastfeeding. Women with epilepsy should be encouraged to breastfeed their children irrespective of antiepileptic drug treatment.

Neurologist knowledge about interactions between antiepileptic drugs and contraceptive methods

“…Inappropriate use of hormonal contraceptive methods can increase the risk of unplanned pregnancy [10,11] and decrease the control of convulsive seizures [12]. Additionally, there is an increased risk of teratogenicity among pregnant women receiving AEDs [13], whereas the use of AEDs during lactation and breastfeeding has no adverse effects on the newborn [14].…”

“…The establishment of effective contraception is, therefore, a challenge for general practitioners, gynecologists, obstetricians, and neurologists. Several studies have indicated poor knowledge about the effects of AEDs on contraception among these health professionals [7,8,13–19], as well as a lack of knowledge about WHO medical eligibility criteria for contraceptive use [2]. The few studies that have assessed neurologists’ knowledge about the interaction of hormonal contraception with AEDs had low response rates and did not specifically evaluate WHO medical eligibility criteria as a reference for the prescription of contraceptive methods among women with epilepsy [16–18].…”