Breastfeeding and Neurodevelopmental Outcomes in Children of Women Taking Antiseizure Medications
Yi Li, David W. Loring, Morris J. Cohen, Elizabeth E. Gerard, Angela K. Birnbaum, Abigail G. Matthews, Page B. Pennell, Kimford J. Meador, , Maurice Druzin, Richard Finnell, Gregory Holmes, Frederick T. McElrath, Lorene Nelson, Zachary Stowe, Linda Van Marter, Peter Wells, Mark Yerby, Eugene Moore, Ryan May, Dominic Ippolito, Lisa Davis, Nilay Shah, Brenda Leung, Mark Friedman, Traci Sheer, Yue Wang, Suzanne Strickland, Erin Latif, Yong Park, Delmaris Acosta-Cotte, Patty Ray, Kirsten Cleary, Joyce Echo, Annette Zygmunt, Camilla Casadei, Mary Dolan, Kim Ono, Donald Bearden, Christine Ghilian, Diane Teagarden, Melanee Newman, Paul McCabe, Michael Paglia, Rosemarie Delucca, Kristina Blessing, Katrina Boyer, Ellen Hanson, Amy Young, Paige Hickey, Jolie Strauss, Hayley Madeiros, Li Chen, Stephanie Allien, Yvonne Sheldon, Taylor Weinau, Elizabeth Shashkova, Melanie Choe, Gregory L. Barkley, Marianna Spanaki-Varelas, Andrea Thomas, Jules Constantinou, Nazin Mahmood, Vibhangini Wasade, Shailaja Gaddam, Andrew Zillgitt, Taimur Anwar, Carla Sandles, Theresa Holmes, Emily Johnson, Gregory Krauss, Shari Lawson, Alison Pritchard, Matthew Ryan, Pam Coe, Katie Reger, Jenny Pohlman, Alisha Olson, Anna Steele, Hadley Lange, Patricia Chang, Sarah Ellis, William Schweizer, Chris Morrison, William MacAllister, Tobi Clements, Hima Bindu Tam Tam, Yael Cukier Cukier, Erica Meltzer Meltzer, Jacqueline Helcer Helcer, Connie Lau Lau, William Grobman, Joseph Coda, Emily Miller, Irena Bellinski, Elizabeth Cunningham, Casey Krueger, Jordan Seliger, Jennifer DeWolfe, John Owen, Matthew Thompson, Cheryl Hall, David Labiner, James Maciulla, Jennifer Moon, Kayla Darris, Michael Privitera, Kellie Flood-Schaffer, George Jewell, Lucy Mendoza, Naymee Velez-Ruiz, Enrique Serrano, Yasin Salih, Gustavo Rey, Christin Bermudez, Michelle Miranda, Pedro Figueredo, Anto Bagic, Alexandra Urban, Satya Gedela, Christina Patterson, Arundhathi Jeyabalan, Krestin Radonovich, Melissa Sutcliffe, Susan Beers, Carrie Wiles, Sandra Alhaj, Alice Stek, Sonia Perez, Rachel Sierra, John W. Miller, Jennie Mao, Michelle Kim, Andrea Cheng-Hakimian, Jennifer Steele, Lamar Parker, Melissa Morris, Jessica Dimos, Danielle CulbrethImportance
Concerns regarding infant exposure to antiseizure medications (ASMs) via breast milk frequently discourage breastfeeding in women with epilepsy (WWE). Longitudinal neurodevelopmental data for breastfeeding while taking contemporary ASM regimens are essential for evidence-based management.
Objective
To evaluate the association between breastfeeding duration and neurodevelopmental outcomes at age 6 years in children exposed to contemporary ASM regimens.
Design, Setting, and Participants
The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs study is a prospective, multicenter, cohort study. Pregnant WWE and healthy pregnant women were enrolled from December 2012 to October 2016, with children followed up to age 6 years. Children’s outcomes were analyzed between January 2023 and December 2024.
Exposures
Breastfeeding duration (none, <6 months, ≥6 months) and children’s exposure to contemporary ASMs (primarily levetiracetam and lamotrigine).
Main Outcomes and Measures
The primary outcomes at child age 6 years included verbal language (Verbal Index Score) and adaptive behavior (General Adaptive Composite score in Adaptive Behavior Assessment System Scale).
Results
A total of 273 children of WWE (median [range] maternal age, 31.0 [19.0-46.0] years; 127 [46.5%] male) and 84 children of healthy women (median maternal age, 31.0 [15.0-38.0] years; 47 [56.0%] male) were included, with 262 children of WWE and 80 children of healthy women in the language outcome sample and 261 children of WWE and 83 children of healthy women in the behavioral outcome set. Adjusted mean (SD) verbal language (107.93 [0.71] vs 107.18 [1.40]; difference, 0.75; 95% CI, −2.40 to 3.89;
Conclusions and Relevance
In this cohort study of children born to WWE, breastfeeding while taking contemporary ASM regimens was not associated with adverse neurodevelopmental outcomes at age 6 years. The observed improved adaptive behavioral outcome supports clinical recommendations for extended breastfeeding (≥6 months) in WWE.