Epilepsy drugs safe for breastfeeding moms
Using epilepsy medication while breastfeeding won't harm your baby's IQ.

Despite concerns that breastfeeding while Mom is on epilepsy medication could hinder infants' cognitive development, a  study finds no evidence of harm to early-childhood IQ.

Most infants born to women with epilepsy will have been exposed to anti-epilepsy medication in the womb, as most pregnant women with the disorder need to stay on medication to adequately control their seizures.

But the question of whether mothers should further expose their babies to the drugs after birth through breastfeeding has remained open.

The new findings, offer some reassurance to new mothers on anti-seizure medication who would like to breastfeed. But experts also caution that the study represents a first step in understanding the interactions between breastfeeding, epilepsy medication and children's brain development.

For now, parents still need to weigh the benefits linked to breastfeeding -including lower risks of early-life infections, eczema, asthma and sudden infant death syndrome - against the theoretical risks of exposing their babies to anti-seizure drugs through breast milk.

The researchers followed 199 children whose mothers were on one of four anti-seizure drugs during and after pregnancy; the drugs included valproate (Depakine, Epilim), carbamazepine (Carbatrol, Tegretol), lamotrigine (Lamictal) and phenytoin (Dilantin).
Overall, 42% of the children were breastfed - for anywhere from three months to two years, but typically for six months.

When they took standard cognitive tests at the age of 3, the kids showed no evidence that exposure to anti-seizure medication through breastfeeding had harmed their IQs.

The average IQ score in the breastfed group was 99, compared with 98 in the bottle-fed group - both being comparable to the average IQ score for children this age in the general population. None of the individual medications was linked to a potential effect on IQ either, though the number of children in each drug-specific group was small.

Various epilepsy drugs differ in the degree to which they are absorbed into breast milk and in how they would be metabolized by the baby. So it is possible that different medications, when transmitted via breast milk, could differ in any effects they have on infants' cognitive development.

Guidelines from the American Academy of Neurology and American Epilepsy Society suggest that during pregnancy, women take only one anti-seizure medication whenever possible, at the lowest dose possible, in order to lower the chances of birth defects.

In particular, women are advised to avoid valproate during pregnancy whenever possible. (For some women, however, the drug is the only one that controls their seizures, and uncontrolled seizures during pregnancy are a danger to both the expectant mother and foetus.) Two other medications - phenobarbital (Luminal) and phenytoin - should be limited during pregnancy as well.

Are you taking medication while breastfeeding?

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