Study: Breastfeeding OK for moms with epilepsy
November 24th, 2010
04:01 PM ET

Study: Breastfeeding OK for moms with epilepsy

Women who have epilepsy have always faced a dilemma when it came to having babies.  It's a difficult balancing act between taking antiepileptic drugs, known as AEDs, during their pregnancy and protecting their unborn children from the risks associated with the medication, like birth defects and adverse cognitive effects.  That balancing act continues for new mothers who want to breastfeed but worry about continuing to expose their infants to their medication.

Now a study in the journal Neurology takes some of that worry away.  According to the research, breastfeeding while taking antiepileptic medication is not associated with an increased risk of adverse events.  Researchers enrolled 195 pregnant women from around the country.  Each woman took one of four popular antiepileptic medications throughout her pregnancy: Carbamazepine, lamotrigine, phenytoin, or valproate.  Nearly half of those women went on to breastfeed their newborns.  Once each child reached the age of three, researchers tested their IQ.

 "We found there's no difference whether women breastfed or not," says Dr. Kimford Meador, lead study author and Professor of Neurology at Emory University. "The IQs were 99 [for children who were breastfed] and 98 [for children who were not] so they were almost the same and both were very similar to the general population, which is 100."

Meador doesn't know for sure, but thinks there are two reasons why the children weren't adversely affected by the medication. While in the womb, babies are already exposed to a low dose of the drugs since most physicians will adjust the medication so it's as low as possible while still being effective.

"We think these effects are dose dependent," explains Meador. "The higher the dose you take, the more likely you are to get malformations." Conversely, decreasing the dosage also decreases the likelihood that the baby will be overly exposed.

Secondly, the only way a baby can be exposed to the medication after being born is through breastfeeding.  But babies have a faster metabolism after leaving the womb.  Since they metabolize breast milk very quickly, researchers believe these babies are getting very little exposure to the medications.

"These women have to take medication during their pregnancy because the risk of seizures to them and their unborn child is worse than the potential risk of malformation or any cognitive effects," says Meador.

The medications aren't without risk, however. Valproate has long been known to cause cognitive impairment when taken during a pregnancy.  In fact, the American Academy of Neurology says pregnant women or women who want to become pregnant and who are taking valproate should consult their doctors about switching their medication.

"A woman with epilepsy shouldn't feel she can't have a child," says Meador. "It's just that we have issues that need to be better addressed before she gets pregnant." Which is why Meador recommends that women with epilepsy talk to their doctor early and often about their medication options, before they become pregnant.

He also says women with epilepsy should feel empowered to breastfeed their baby, if they choose.

"What I say to my patients is that we have strong evidence that breastfeeding is positive to both the mother and her child," says Meador. "We have a known health benefit versus a theoretical risk that has not been supported by the one study looking at it.  I recommend to them to breastfeed if they want to, with the caveat that we don't know absolutely for sure [if it causes any harm]."

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