Findings from 2 clinical studies presented at the American Epilepsy Society Annual Meeting, December 6-10 in Baltimore, MD show that women with epilepsy are less likely to breastfeed their newborns than new mothers without epilepsy. Support from neurologists and lactation consultants, however, can reassure them that breastfeeding is safe and beneficial for the baby.
In the first study, researchers compared rates of breastfeeding between 102 women with epilepsy and 113 women who did not have the condition. They also assessed the reasons for the discrepancy and whether support made a difference.
The researchers found that at the child’s birth, 51% of women with epilepsy breastfed, compared to 87% of those without the condition. At 6 weeks, 38.2% of the women with epilepsy breastfed, compared to 76% of women without epilepsy.
The reasons for not breastfeeding were noted for 17.6% of women with epilepsy and included inability of the baby to latch, fear of exposing their babies to antiepileptic drugs (AEDs) through breast milk, recommendations by healthcare providers not to breastfeed, and lack of milk supply.
The researchers also assessed the effect of support and found 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.
The second study was the ongoing Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) trial (NCT01730170) of pregnancy outcomes for women with epilepsy and their children. In the study, 294 women with epilepsy and 89 women without epilepsy were asked if they breastfed their infants at 3 months, 6 months, 9 months, and 12 months postpartum.
Researchers found that women with epilepsy were significantly less likely to breastfeed at birth and at 3 months 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 epilepsy
• At 3 months, 59.2% of women with epilepsy breastfed vs. 78.7% of those without epilepsy
• 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
Epilepsy specialists typically encourage breastfeeding, but other healthcare providers who are not familiar with evidence of its safety and benefits may discourage women with epilepsy, believing that AEDs may harm their babies. Some also fear that disrupted sleep due to nighttime feedings can trigger seizures.
“Most epilepsy experts agree that the known benefits of breast milk outweigh the mostly theoretical risks of exposure to most AEDs,” said Elizabeth E. Gerard, MD, associate professor of neurology, Northwestern University Feinberg School of Medicine.
“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 Abrar Al-Faraj, instructor of neurology at Boston University School of Medicine. “The neurologist can reassure women that in most cases, breastfeeding is safe and should be encouraged.”
Ilka Kleffner, MD; Catharina C. Gross, PhD; Marius Ringelstein, MD; Jörg Rehrmann, MD; Markus Kraemer, MD; and Jan Dörr, MD
Shruti Bhandari, MD; Rohit Kumar, MD; Megan Nelson, MD; Donald Miller, MD; and Brian J. Williams, MD
Peter McAllister, MD