WASHINGTON, DC—Children who have been breastfed by mothers with epilepsy who were taking antiepileptic drugs (AEDs) have no adverse cognitive effects at age 6, reported Kimford J. Meador, MD, at the 67th Annual Meeting of the American Epilepsy Society. The children also had a higher IQ and verbal index score than children who were not breastfed.
“Our results are encouraging, in that women with epilepsy can be less fearful of breastfeeding their babies,” said Dr. Meador, Acting Professor of Neurology and Neurological Sciences at the Stanford University School of Medicine in California. “Nevertheless, this is a limited study, and additional research is needed.”
Kimford J. Meador, MD
Dr. Meador and colleagues conducted the prospective Neurodevelopmental Effects of Antiepileptic Drugs study that enrolled pregnant women with epilepsy in the United States and United Kingdom between 1999 and 2004. All women were on monotherapy, which consisted of carbamazepine, lamotrigine, phenytoin, or valproate. The new analysis provides an update to previously reported data regarding the children’s cognitive status at age 3. No adverse effects on IQ were found at that time. “Age 6 is more predictive of school performance and adult abilities,” Dr. Meador explained.
To assess long-term neurodevelopmental effects in 181 children, the researchers used the Differential Abilities Scales. The study authors also assessed function in other cognitive domains, including verbal index, nonverbal index, memory index, and executive index.
“Results were analyzed as a function of whether the children had been breastfed,” stated Dr. Meador. The investigators used a linear regression model with age 6 IQ as the dependent variable in their primary analysis, and they conducted similar secondary analyses for the other cognitive measures. All mothers continued to take AEDs after giving birth, according to Dr. Meador.
The researchers found that 43% of the children had been breastfed, and the average duration of breastfeeding was 7.2 months. The investigators observed no statistical difference in breastfeeding rates among all AED groups. The most significant independent variables for predicting IQ at age 6 were maternal IQ, AED group, AED dose, periconceptional folate level, and breastfeeding.
“IQ was higher overall by four points for children who were breastfed [average IQ, 108] versus those who were not breastfed [average IQ, 104],” stated Dr. Meador. “For the other cognitive domains, only verbal index differed across the breastfed and nonbreastfed groups [average IQ, 105; and average IQ, 102, respectively], with a higher score for breastfed children.
“Our study does not provide a final answer, but at the present, we recommend breastfeeding to our mothers with epilepsy, informing them of the strength of evidence for risks and benefits,” Dr. Meador commented. “Our recommendation is based on the known positive effects of breastfeeding, the results of our study, an unsubstantiated theoretical risk, and theoretical reasons why breastfeeding on AEDs would not offer additional risk.”
—Colby Stong