At age 6 months, infants of mothers using antiepileptic drugs (AEDs) (n = 223) had a higher risk of impaired fine motor skills (11.5%), compared with a reference group of children of parents without epilepsy (4.8%), especially when the infants were exposed to multiple AEDs, according to a study published in the November 2013 issue of JAMA Neurology. However, because breastfeeding in women using AEDs was not associated with any harmful effects on child development at ages 6 to 36 months—and was even found to protect against low weight during the postnatal period—the study’s authors concluded that women with epilepsy should be encouraged to breastfeed their children regardless of antiepileptic medication use.
The study was part of the prospective Norwegian Mother and Child Cohort Study (MoBa) in which women in Norway, recruited at 13 to 17 weeks of pregnancy, reported on their child’s development at 6 months (n = 78,744), 18 months (n = 61,351), and 36 months (n = 44,147) using validated screening tools and also provided detailed information on breastfeeding during the first year. For the substudy examining the developmental effects of prenatal exposure to AEDs, all 974 children of mothers or fathers with validated epilepsy in the MoBa cohort at 6 months formed the epilepsy group, while the remaining 77,770 children of parents without epilepsy served as the reference group. Exposure to AEDs by mothers during pregnancy and by fathers within 6 months prior to conception was also validated.
Significantly different results were seen for children of women who used AEDs compared with children of women who did not use the drugs and to children of men with epilepsy—two subgroups found to have normal development at 6 months. For example, children of mothers using multiple AEDs had the highest risk for impaired motor skills (25.0%, vs 4.8% for the reference group) while also having impaired social skills (22.5% vs 10.2%, respectively).
By contrast, continuous breastfeeding during the first 6 months was associated with a tendency toward improved outcome for all the developmental domains measured regardless of maternal AED treatment. At 18 months, while children in the drug-exposed group had an increased risk of impaired development compared with the reference group, the risks tended to be elevated particularly in children whose breastfeeding had been discontinued. At 36 months, prenatal AED was associated with adverse development regardless of breastfeeding status during the first year.
—Fred Balzac