EAN 2023 | An update on lactation and antiseizure medications
Bruna Nucera, MD, Hospital of Merano, Merano-Meran, Italy, explores the topic of breastfeeding in women with epilepsy. The rates of breastfeeding among women with epilepsy are low, with only 42% breastfeeding at three months, and in general, women with epilepsy discontinue breastfeeding more often than women without epilepsy. However, there are numerous benefits of breastfeeding for both mother and child that should be considered, including a reduced risk of metabolic diseases and breast and ovarian cancer for the mother. The main reason for discontinuing breastfeeding in women with epilepsy is the fear of drugs transferring to the child through breast milk and causing adverse events. Dr Nucera acknowledges the difficulty in estimating the effects of drugs on breastfed infants due to various factors such as drug type, protein binding, fat solubility, and child-related factors. Overall, it is challenging to suggest not breastfeeding for women with epilepsy, as the likelihood of adverse effects is low. This interview took place at the European Academy of Neurology (EAN) 2023 Congress in Budapest, Hungary.
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Transcript (edited for clarity)
I think that is important to talk about lactation and anti-seizure medication because we know from literature data that patients with epilepsy have in general low rates of breastfeeding. In fact, only 42% of women with epilepsy breastfeed at three months. And in general, women with epilepsy discontinue breastfeeding more often than women without epilepsy. We know also from literature data that the benefit for breastfeeding for both mother and child regarding health in acute and for long term outcome, it reduces the risk for metabolic diseases, for example type 2 diabetes, it also reduces the risk of breast and ovarian cancer in mother...
I think that is important to talk about lactation and anti-seizure medication because we know from literature data that patients with epilepsy have in general low rates of breastfeeding. In fact, only 42% of women with epilepsy breastfeed at three months. And in general, women with epilepsy discontinue breastfeeding more often than women without epilepsy. We know also from literature data that the benefit for breastfeeding for both mother and child regarding health in acute and for long term outcome, it reduces the risk for metabolic diseases, for example type 2 diabetes, it also reduces the risk of breast and ovarian cancer in mother. So, it’s really important to encourage breastfeeding in women with epilepsy for these important benefits.
The most important reason that women with epilepsy discontinue breastfeeding is the fear that drugs taken by the mother could transfer via breast milk to the child and could cause acute and long-term adverse events. But the possible effect that any drugs could cause in the breastfed infant is really difficult to estimate because it depends on several factors. For example factors related to the mother, for example type of drugs, dosage of drugs, maternal serum concentration. It also depending on type of the drugs, for example, we know that drugs differ in protein binding, in fat solubility. And finally also depend on child related factors: we know also that it depends on the age of the child, for example, (risk) is higher for premature or a child with an age that is less than 2 or 3 months. So, we have several independent factors that work together to determine the possible effect of the drugs on the child. So, it’s really hard to suggest not breastfeeding in our patients when we have the possibility of any factor is really low.
The possible effect that any drugs could cause in the infant is, as I said before, acute and long term. About acute, for example, sedation is the most important acute adverse effect of different anti-seizure medication. Other acute effects could differ from different anti-seizure medications, for example lamotrigine could cause also rash and so on. About the long-term adverse events it is particularly the cognitive outcome, we have to take into account this data also. And there are several studies that were conducted to examine the possible effect of the drugs in acute and long-term events. What we know in summary, is that the outcome in a six-year-old infant that was exposed during breastfeeding to anti-seizure medication depended on type of drugs, for example, it was worse with valproate. And also the number of drugs. It was worse with polytherapy and the dosage. What is important is to assess the possible acute (symptoms), the possible sedation, tremor, changing clinically in the baby, and also to assess the long-term cognitive outcome in our patients.
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