Breastfeeding while taking AEDs

[Bernard]

Breastfeeding While Taking Seizure Medicine Does Not Appear to Harm Children

CHICAGO – A first of its kind study finds breastfeeding while taking certain seizure medications does not appear to harm a child's cognitive development. The research will be presented at the upcoming American Academy of Neurology 60th Anniversary Annual Meeting in Chicago, April 12–19, 2008.

"Our early findings show breastfeeding during anti-epilepsy drug treatment doesn’t appear to have a negative impact on a child's cognitive abilities," said study author Kimford Meador, MD, with the University of Florida at Gainesville, and Fellow of the American Academy of Neurology. "However, more research is needed to confirm our findings and women should use caution due to the limitations of our study."

Researchers tested the cognitive development of 187 two-year-old children whose mothers were taking the epilepsy drugs lamotrigine, carbamazepine, phenytoin, or valproate. Forty-one percent of the children were breastfed.

The study found breastfed children had higher cognitive test scores than those children who were not breastfed, and this trend was consistent for each anti-epilepsy drug. The children who were breastfed received an average test score of 98.1 compared to a score of 89.5 for the children not breastfed. However, the results were not significant after adjusting for the mother’s IQ. Thus, it appears that the higher scores in children who were breastfed is due to the fact that their mothers had higher IQs.

Meador says animal studies have shown that some anti-epilepsy drugs, but not all, can cause cells to die in immature brains, but this effect can be blocked by the protective effects of beta estradiol, which is the mother’s sex hormone. “Since the potential protective effects of beta estradiol in utero are absent after birth, concern was raised that breastfeeding by women taking anti-epilepsy drugs may increase the risk of anti-epilepsy drug-induced cell death and result in reduced cognitive outcomes in children.”

Meador says additional research on the effects of breastfeeding should be extended to other anti-epilepsy drugs and mothers who use more than one anti-epilepsy medication.

The study is part of an ongoing study of the long-term effects of in utero anti-epilepsy drug exposure on children’s cognition. Women with epilepsy who were taking anti-epilepsy drugs were enrolled in the study during pregnancy. Ultimately, the study will examine the effects of in utero anti-epilepsy drug exposure on children at six years old.

Breastfeeding While Taking Seizure Medicine Does Not Appear to Harm Children

[angel]

I've have four children and no way would I have breast fed them while taking anti epilepsy drugs. "scary"

[Bernard]

Stacy's doctors always told her that the benefits far outweighed the risks, but they never supported those claims with anything, so I was pleased to see this bit of research. Hopefully there will be further studies on this issue.

[minnbikergirl]

it has been 27 years since I had my first child, but I breast fed him for about a month. I was pretty drugged up too. My son slept and slept and slept. My husband and I thought wow..this is great !!! Then I went to the doctor and told him that my baby was sleeping through the night, and he told me to quit breastfeeding him. I did not breast feed my second child, and I was put on different drugs. I truely believe my medication affected both my children, but my first child more. I lived out west, and had a "mountain" doctor. He told me the more I ate, the less medicine the baby would get, so it was during Christmas, and I drank egg nog like it was going out of style. I gained over 75 pounds !!! Both my children are healthy,good boys. I do believe that breast feeding does affect the baby big time !!!!

[brain]

I breastfed my son, and he's 23 years old now.

[Milagro]

I breastfed my son, and he's 23 years old now.

How did he turn out?

[Ruth]

When I was pregnant, I was not told one way or the other to breastfeed. I did not want to take any chances. I decided without asking the doctors not to breastfeed.

I felt that their was always the risk of my medicines harming my babies. I do not know if there was, I just did not want to take the risk.

[janey]

Before I had my children, I talked to the pediatrician and he told me that since they had been exposed to the drugs before they were born, this was a way to wean them more gradually from them. This was over 30 years ago, and not quite 29 years ago.

I was just looking up meds today and ended up on the NYU Langone Medical Center site and wording similar to this appears at the bottom of most (not all meds): "That said, it is strongly felt by neurologists and epileptologists that the benefits of breastfeeding largely outweigh the risks of exposing the baby to antiepileptic medications, including ****. As a matter of fact, the American Academy of Neurology and the American Epilepsy Society both recommend breastfeeding in women with epilepsy."

(Sorry, I'm a newbie so I can't post a link yet.)

[Ruth]

Hi Janey

Welcome to CWE. We are glad to have you here. Do not worry, I do not know how to post a link. I look up the other links that people put in here. There are quite a few.

When I was pregnant with epilepsy, they did not have the research that they have today. It was about 40 years ago. I am 65. Breastfeeding is better for any mother and baby. The mother bonds with the baby more. The milk is better than cow's milk for the baby. You are about my age. You must have had more knowelageble doctors than I did.

That is great that you are doing research. I love doing research.

[janey]

Feast, Thanks!

I got so mad at the dr before the one I'm seeing now that I told her that if she wasn't able to take the time to give me straight answers, at least tell me where she got the info and I'd go to the med school library and look it all up. She was not exactly happy with me at that one!

It is what happens when you are first diagnosed while in college and used to doing research. I've been doing research since I had to go to a special library and pay for copies in order to read things

I've told the newest doc that he is paying for the inconsideration of all of his predecessors. Mostly I'm just glad that someone is saying that in most instances it is best for moms and babies.

Be aware, however, that since they may have to raise your dose while pregnant that someone is going to help you get it down as fast as you need to. I had a great OB nurse who recognized Dilantin overdose and who when we were not able to get in touch with any docs (how could I manage to have multiple docs all with the same mid-week day off) was willing to tell me that I could legally refuse any meds.

[epileric]

There's a cool chart towards the bottom

Although anticonvulsants are excreted into breast milk, most mothers who require the use of these drugs can safely breast-feed their infants.12,13 Determination of maternal serum drug levels may be a useful adjunct to clinical monitoring of the infant when evaluating the drug exposure of the infant.

Phenytoin (Dilantin) and carbamazepine (Tegretol) are compatible with breast-feeding.6,8,10,12 Although the AAP considers valproic acid and its derivatives (valproic sodium and divalproex sodium) to be compatible with breast-feeding, some experts recommend against their use during breast-feeding because of the potential for fatal hepatotoxicity in children younger than two years.6,10,12

During breast-feeding, anticonvulsants other than phenobarbital and primidone (Mysoline) are preferred because the slow rate of barbiturate metabolism by the infant may cause sedation.6,10,12 Infant serum levels may be helpful in monitoring toxicity.

http://www.aafp.org/afp/2001/0701/p119.html

[Mommie2my4Angels]

I breastfed 20 months while on Tegretol and must say I have a beautiful and intelligent "tegretol" Baby. My son has made every milestone along the way as well as already knows Abcs' colors. Shapes, counting to 10, animal sounds, ect... he is only 2 years old. I was scared my entire pregnancy I won't lie, but it was the right choice for us and breastfeeding can be the right choice as well

[skillefer]

My Abby is 9 mos old and very healthy. She's meeting all of her milestones on time..and even ahead of time in some cases. And yes, I chose to breastfeed. I think that the benefits outweigh the risks and would do the same again.

[angeldust]

Hi


I have had a child who is 9 now.I breastfed him for only about 2 months as he just didn't seem to put on any weight while breastfeeding and was underweight.I was on Epilim on the time and no one told me I shouldn't breastfeed or that there would be any risk.He is very intelligent and ahead of his class.A bright kid.
I am now pregnant again and am on Lamotrogine.200 mg a day.I went on this to get pregnant as Epilim was not safe I was told especially the dose I was on.I only started taking Epilim after my first childs birth as his birth was what brought on the seizures.I hadn't had one since I was 12-13 and never before had I had a tonic clonic.
I have been told with the Lamotrogine I should not breastfeed .I am disappointed as I didn't get to do it properly last time and would have loved to this time.
Has anyone breastfed on Lamotrogine before and have your kids had any side effects?

[Mommie2my4Angels]

I could not tolerate that medication due to a severe allergic reaction, if you don't find answers here I know there are lots of answers out there I extensively researched breastfeeding and anti-epileptic drugs before my son was born. Feel free to message me of you need help I remember how scared and alone I felt those 9 months waiting to meet my little guy.

[Zoofemme]

I think intelligence has more to do with genetics than brestfeeding. I might not be able to spell for crap right now but I'm a bottle fed baby...all of my brothers were breast fed... and my IQ is significantly higher than theirs. Genetically, as near as anyone has been able to figure out, I must take after someone on my father's side (he was adopted). It definitletly is'nt on my mother's side.

There are two ways to argue this:
A perso with E has already been exposing there baby to meds...is what the baby will get thru brestfeeding going to be that much more significant than what it was getting in the womb; providfing the mothers dosage wasn't increased or meds changed?

Does the mother with E want to contue exposing their baby to anti-epileptic drugs any longer than abolutely necessary for what might be altruistic reasons (IQ, its more natural, environmentally friendly, etc)? Knowing what the anti-epileptic drugs and there side effects does to her? A baby doesn't necessarily have anyway of telling anyone that something is making them feel wonky or dizzy or anything else. THey can cry, but babies cry for a lot of reasons.

[Ruth]

When I was pregnant with my last baby, I proudly told my neurologist. He told me that I could not have children because I was on Depakote. Depakote is a very dangerous med for a baby. My neurologist did not tell me this before I got pregnant.

He wanted me to have an abortion. I said no, I will not murder my baby!! My baby was born and was very slow in learning. I made learning fun for him!!

[Mommie2my4Angels]

You state some very good points that I had to deal with as I decided to breastfeed my son. For me I was lucky I was lowering my dose. When pregnant my Tegretol dose was raised to the max dose for me of 1600 mg and after delivery was being taperd down while breastfeeding my son was able to taper down with me as well, the way I felt it was like not making his stop the drug cold turkey that he had in his system from conception.

I think intelligence has more to do with genetics than brestfeeding. I might not be able to spell for crap right now but I'm a bottle fed baby...all of my brothers were breast fed... and my IQ is significantly higher than theirs. Genetically, as near as anyone has been able to figure out, I must take after someone on my father's side (he was adopted). It definitletly is'nt on my mother's side.

There are two ways to argue this:
A perso with E has already been exposing there baby to meds...is what the baby will get thru brestfeeding going to be that much more significant than what it was getting in the womb; providfing the mothers dosage wasn't increased or meds changed?

Does the mother with E want to contue exposing their baby to anti-epileptic drugs any longer than abolutely necessary for what might be altruistic reasons (IQ, its more natural, environmentally friendly, etc)? Knowing what the anti-epileptic drugs and there side effects does to her? A baby doesn't necessarily have anyway of telling anyone that something is making them feel wonky or dizzy or anything else. THey can cry, but babies cry for a lot of reasons.