Breastfeeding Rates Significantly Lower in Women with Epilepsy, Studies Show Neurologist, Lactation Consultant Support Can Make a Difference

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Breastfeeding Rates Significantly Lower in Women with Epilepsy, Studies Show
Neurologist, Lactation Consultant Support Can Make a Difference

BALTIMORE – Women with epilepsy are less likely to breastfeed their newborns than new moms without the condition, but support and encouragement from neurologists and lactation consultants who can reassure them it is safe and beneficial for the baby may help improve the rates, suggests research being presented at the American Epilepsy Society Annual Meeting.

While epilepsy specialists typically encourage breastfeeding, other health care workers who are not familiar with the evidence of its safety and benefits may discourage women with epilepsy, believing that the antiepileptic drugs (AEDs) the women take to control their seizures may harm their babies. Some also fear that disrupted sleep due to nighttime feedings can trigger seizures. As a result, women with the condition are less likely to breastfeed.

“We need to understand and address the challenges women with epilepsy face beyond seizure control and medication management when they are being seen by various health care providers to ensure the best quality of life for them and their babies,” said Abrar Al-Faraj, M.D., lead author of one of two breastfeeding studies being presented at AES and instructor of neurology at Boston University School of Medicine. “The strong efforts to advocate for breastfeeding in the general population should include women with chronic diseases such as epilepsy.”

For many AEDs, the drug levels in children who are breastfed are substantially lower than in the mother, and lower than the infant’s exposure before birth.1,2 Further, women whose seizures worsen due to sleep deprivation can be encouraged to pump milk, which can be provided to their babies by family members during night feedings.

“Most epilepsy experts agree that the known benefits of breastmilk outweigh the mostly theoretical risks of exposure to most AEDs,” said Elizabeth E. Gerard, M.D., lead author of the second study and associate professor of neurology at the Northwestern University Feinberg School of Medicine in Chicago. “Two prior studies have prospectively examined the effects of breastfeeding in women taking AEDs and neither found adverse effects of breastfeeding on outcomes at 3 years.3,4 The NEAD study, the precursor to our current study, followed the AED-exposed children to age 6 and found superior cognitive outcomes among those who were breastfed.5

In most cases, women taking carbamazepine, lamotrigine, levetiracetam, or valproic acid should be encouraged to breastfeed, she said. There is less safety information about some AEDs, such as benzodiazepines, ethosuxamide, oxcarbazepine, topiramate, phenobarbital and zonisamide. However, the mostly theoretical risk of infant exposure to these medications through breastmilk needs to be weighed against the many known benefits of breastfeeding, the researchers note. Women who take these medications should consult with an expert to help them understand the benefits of breastfeeding and the information available on these medications.

Support and education help increase breastfeeding rates in women with epilepsy

In the first study, the researchers – including Dr. Al-Faraj and the principal investigator, Trudy D. Pang, M.D., of Beth Israel Deaconess Medical Center, Boston – compared the rates of breastfeeding among 102 women with epilepsy and 113 women who did not have the condition, assessed the reasons for the discrepancy and looked at whether support made the difference. The women were treated between 2008 and 2017 at Beth Israel Deaconess Medical Center. Researchers found:

  • At the child’s birth, 51% of women with epilepsy breastfed vs. 87% of those without epilepsy
  • At 6 weeks, 38.2% of women with epilepsy breastfed vs. 76% of women without the condition

The reasons for not breastfeeding were noted for 17.6% of women with epilepsy and included technical difficulties such as the inability of the baby to latch, fear of exposing their babies to AED medication through breastmilk, recommendations by pediatricians and obstetricians not to breastfeed and lack of milk supply. Further, women with epilepsy were much less likely to receive lactation consultation after birth: at one hospital, only 13% of women with epilepsy received lactation consultation compared to 58% of women who did not have epilepsy.

Researchers then assessed the effect of breastfeeding support and determined that 37% of women with epilepsy who received breastfeeding education from their doctor initiated breastfeeding, and 77% of those who had a lactation consultation initiated breastfeeding. Women who received these types of support were more likely to continue to breastfeed as well.

“A woman with epilepsy should always discuss her treatment and ask about breastfeeding with her neurologist to ensure safety, especially if she is taking more than one medication,” said Dr. Al-Faraj. “The neurologist can reassure women that in most cases breastfeeding is safe and should be encouraged.”

MONEAD study confirms women with epilepsy less likely to breastfeed 

The second study reports breastfeeding findings from the ongoing Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study of pregnancy outcomes for women with epilepsy and their children. At their child’s birth and at 3, 6, 9 and 12 months postpartum 294 women with epilepsy and 89 women without the condition were asked if they were breastfeeding their infants. Researchers determined that women with epilepsy were significantly less likely to breastfeed at birth and at 3 and 6 months after birth, but if they initiated breastfeeding they were just as likely to continue.

  • At the child’s birth, 73.5% of women with epilepsy breastfed vs. 88.8% of women without the condition
  • At 3 months, 59.2% of women with epilepsy breastfed vs. 78.7% of those without the condition
  • At 6 months, 47.2% of women with epilepsy breastfed vs. 69% of those without epilepsy
  • At 9 months, 39.9% of women with epilepsy breastfed vs. 51.3% of women without epilepsy
  • At 12 months, 27.8% of women with epilepsy breastfed vs. 37.5% of women without epilepsy

“Although women with epilepsy initiate breastfeeding at lower rates than those without epilepsy, our research suggests if they start breastfeeding, they are similarly successful at continuing,” said Dr. Gerard. “More research is needed to understand the reasons women with epilepsy are less likely to initiate breastfeeding and how we can support breastfeeding in these women.”

About the American Epilepsy Society

Founded in 1946, the American Epilepsy Society (AES) is a medical and scientific society whose members are dedicated to advancing research and education for preventing, treating and curing epilepsy. AES is an inclusive global forum where professionals from academia, private practice, not-for-profit, government and industry can learn, share and grow to eradicate epilepsy and its consequences. 

For more information, visit the American Epilepsy Society online at aesnet.org. Join the AES Annual Meeting social conversation today by following @AmEpilepsySoc on Twitter and use the hashtag #AES2019. 

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  1. Birnbaum AK, et al. Antiepileptic drug exposure in infants of breastfeeding mothers with epilepsy, presented at American Epilepsy Society 70th Annual Meeting, December 2-6, 2016, Houston.
  2. Veiby G, et al. Epilepsy and recommendations for breastfeeding. Seizure 2015;28:57-65.
  3. Meador KJ, et al. Effects of breastfeeding in children of women taking antiepileptic drugs. Neurology 2010;75(22):1954-60.
  4. Veiby G, et al. Early child development and exposure to antiepileptic drugs prenatally and through breastfeeding: a prospective cohort study on children of women with epilepsy. JAMA Neurol 2013;70(11):1367-1374)
  5. Meador KG, et al. Breastfeeding in children of women taking antiepileptic drugs: cognitive outcomes at age 6 years. JAMA Pediatr. 2014 Aug;168(8):729-36

 

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