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Exposure to antiepileptic drugs via breast-feeding did not decrease cognitive function
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Recent data show children who breast-fed from mothers taking antiepileptic drug experienced no adverse cognitive effects.
Kimford J. Meador, MD, department of neurology and neurological sciences at Stanford University, and colleagues assessed cognitive factors of children born to mothers who breast-fed while receiving antiepileptic drug therapy. The study cohort, which consisted of 181 children and 177 mothers, was recruited from 25 epilepsy centers in the United States and United Kingdom between October 1999 and April 2004. Overall, 42.9% of children were breast-fed. Analysis was conducted during breast-feeding and when children were aged 6 years.
Mothers were taking carbamazepine, lamotrigine, phenytoin, or valproate (Depacon, AbbVie, Inc) monotherapy. Mean dosages during pregnancy were 803 mg/day of carbamazepine; 508 mg/day of lamotrigine; 393 mg/day of phenytoin; and 1,160 mg/day of valproate.
Overall, children who were breast-fed had an adjusted IQ that was four points higher than children who were not breast-fed. Higher maternal IQ was associated with higher child IQ. Fetal valproate exposure and higher antiepileptic drug dosage was associated with lower child IQ. Folate use prior to conception was associated with higher IQ.
Regarding other cognitive functions, only verbal abilities differed between children who were breast-fed and those who were not; with higher scores among those who were breast-fed.
The study findings contrast evidence that antiepileptic drugs can produce neuronal apoptosis in immature animal brains and that fetal exposure to some antiepileptic drugs is associated with reduced cognitive function among children, according to researchers.
“The [antiepileptic drug]-induced apoptosis in the immature brain is dose dependent and ultimately related to the actual drug level in the fetus or infant. Furthermore, [antiepileptic drug]-induced apoptosis requires only a single exposure, so it is possible that the adverse effects may be related more to the peak [antiepileptic drug] level than to the total exposure. The [antiepileptic drug] level in the child from breast-feeding is dependent on multiple factors, including the amount of [antiepileptic drug] excreted into breast milk, the amount of [antiepileptic drug] absorbed, and the clearance of [antiepileptic drug] by the infant. Therefore, the amount of [antiepileptic drug] in breast milk may not be directly related to the [antiepileptic drug] serum levels in the infant,” the researchers concluded.
Disclosure: See the study for a full list of disclosures.
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