Antiepileptic drug exposure via breast milk is limited

  • Birnbaum AK & al.
  • JAMA Neurol
  • 30 Dec 2019

  • International Clinical Digest
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Takeaway

  • 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.

 Key results

  • 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).

Study design

  • 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.

Limitations

  • Observational design.
  • Concentrations of AEDs in breast milk unknown.
  • Only single sample per infant.
  • Concentration measured only once between feedings.