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AAN: Epilepsy Treatment No Obstacle for Breastfeeding 4-21-08
Annotated by Dr. Beth Dupree
CHICAGO, April 21 -- Seizure medication taken while breastfeeding appears to
be safe for an infant's developing brain, researchers found.
Children exposed to epilepsy drugs in breast milk had slightly higher cognitive
scores at age two than those who were bottle-fed (1) (96 versus 91,
P=NS), reported Kimford Meador, M.D., of the University of Florida at
Gainesville, and colleagues, in the ongoing Neurodevelopmental Effects of
Antiepileptic Drugs (NEAD) study.
Good evidence from the general population supports a benefit from breastfeeding
for immune function and many other outcomes whereas the risks during epilepsy
treatment are only theoretical, Dr. Meador said at the American Academy of
Neurology meeting here. "My approach has been to encourage women to breastfeed
if they want to do that."
However, women should still use caution until the findings are confirmed by
other studies, he said. The prospective observational NEAD study included a
limited number of families and only common antiepileptic agents.
"It's not definitive, but at least it's a start," he said. "This is a question I
am frequently asked by moms."
However, there's been virtually no evidence with which to answer this question,
he said.
Antiepileptic drugs are known to kill neurons in the developing animal brain,
but studies suggested estradiol blocked this apoptosis, Dr. Meador said. (2)
Breastfeeding was thought to present a unique channel for neurodevelopmental
damage because a child is virtually bathed in the mother's estradiol in utero
but not protected by the hormone after birth, he said. (3)
The NEAD study was designed to determine long-term cognitive effects of in utero
exposure to the most commonly used antiepileptic drugs. It enrolled American and
British women with epilepsy taking monotherapy carbamazepine (Carbatrol, Epitol,
Equetro, Tegretol), lamotrigine (Lamictal), phenytoin (Dilantin, Phenytek), or
valproate (Depakote, Depakene) during pregnancy. Their children will be tested
for neuropsychological effects through age six.
The researchers previously reported that the rate of serious adverse events
defined as death or major congenital malformation differed between drug groups
(P<0.001). Lamotrigine was associated with the lowest rate at about 1% whereas
valproate was associated with the highest rate at about 20%.(4)
Dr. Meador presented data from cognitive testing at age two years on the 187
children still in the study of the original 311 live births. Children were most
commonly exposed to lamotrigine (68) during pregnancy followed by carbamazepine
(48), phenytoin (42), valproate (29).
After adjustment for maternal IQ (5) and epilepsy drug dose exposure,
cognitive scores were lower for valproate than any of the other drugs studied.
Mental Developmental Index (MDI) (6) scores from the Bayley Scales
averaged 84 for valproate-exposed children but 93 to 95 for all other groups.
The valproate effect was dose- and blood level-dependent.
The majority of children were not breastfed (58%), but those who were had better
MDI cognitive scores overall (98.1 versus 89.5, P=0.0012) including each
individual epilepsy drug exposure group.
Dr. Meador concluded that there was no overall deleterious effect from
breastfeeding during antiepileptic therapy, but he cautioned that the study was
underpowered to show a difference in the individual drug categories.
(7)The study was supported by a grant from the National Institute of
Neurological Disorders and Stroke. Dr. Meador reported research support from
GlaxoSmithKline, Eisai, Marius, Myriad, Neurospace, SAM Technology, and UCB
Pharma as well as serving as a contributing editor to Epilepsy Currents. Other
researchers on the study reported conflicts of interest for GlaxoSmithKline,
Ortho-McNeil Pharmaceuticals, UCB Pharma, Epilepsy Currents, Shire
Pharmaceuticals, Janssen-Cilag, Pfizer, Schwarz Biosciences, The Neuroscience
Institute, Johnson & Johnson, Abbott, Valeant, and Novartis.
Comments:
1: Please note that they are comparing cognitive scores between children who are breast fed and exposed to epilepsy drugs, to children who are bottle fed formula.
2: The same studies also found metabolites of particular epilepsy drugs in the urine of the test infants. This is proof that the drugs do pass through breast milk and are digested by the infant.
3: Children are somewhat protected in utero by the placenta, however babies born addicted to illegal drugs, or that contract AIDS from the mother shows that their is no real protection in utero.
4: As with all medical research funded by the drug manufacturer, they are only looking for seriously life altering side effects (death, sever retardation etc..) and not for slight decline in higher functioning or long term nerve damage.
5: the mother's IQ, which has nothing to do with the child's IQ.
6: Test used to determine age appropriate mental, physical, language development in children to young to thoroughly test.
7: Study was funded by the companies that manufacture the drugs tested.
Further Comment:
You should be very careful about what drugs you take during pregnancy. If you must be on any medication, do your research beforehand and switch to the safest form, and get accustomed to it before you get pregnant. Many medications we think are necessary, are not, and can be discontinued during pregnancy and breast feeding. If you are on medications during breastfeeding, It may outweigh the risks involved verses bottle feeding. Check he drugs you are taking to see if they are metabolized through breast milk. All patient inserts will list this or ask your pharmacist. Pharmacists are better at finding safer alternatives than your doctor may be. Tell your Pharmacist what you are planning to do and see if there are safer alternatives.
If you must take epilepsy drugs during breastfeeding you need to supplement and eat things that will support nerve and brain development. Take 1-3000 mg molecularly distilled fish oil, 1000 mg Organic evening primrose oil, and make sure your diet is full of dark colored vegetables, colorful fruits, nuts, seeds, and beneficial oils (olive, almond, flax).