- Blood concentrations of antiepileptic drugs (AEDs) in breastfed infants are generally much lower than in the breastfeeding mother taking these drugs.
- The results suggest that the benefits of breastfeeding outweigh risks in this population.
Why this matters
- The safety of breastfeeding in this setting is unknown.
- 49.3% infants had AED concentrations below the lower limit of quantification.
- Median percentages of AED concentrations in infants relative to breastfeeding mother:
- 0.3% for oxcarbazepine,
- 5.3% for levetiracetam,
- 5.4% for carbamazepine epoxide,
- 5.7% for carbamazepine,
- 17.2% for topiramate,
- 21.4% for valproic acid,
- 28.9% for lamotrigine, and
- 44.2% for zonisamide.
- Correlation (Pearson correlation coefficient) of maternal concentration with infant concentration:
- Significant for lamotrigine: 0.58 (P<.001>
- Not significant for levetiracetam: 0.48 (P=.09).
- Multicenter prospective cohort study of women with epilepsy taking AEDs and their breastfed infants (MONEAD study).
- Main outcome: ratio of infant-to-mother AED concentration in blood samples collected 5-20 weeks after birth.
- Analyses based on 138 infants, 164 matching infant-mother concentration pairs.
- Funding: National Institute of Neurological Disorders and Stroke; National Institute of Child Health and Development.
- Observational design.
- Concentrations of AEDs in breast milk unknown.
- Only single sample per infant.
- Concentration measured only once between feedings.