Dr Abrar Al-FarajAbrar Al-Faraj, MD
New results from a pair of studies presented at the 73rd annual meeting of the American Epilepsy Society (AES), December 6-10, 2019, in Baltimore, Maryland, suggest that women with epilepsy are less likely to breastfeed their children than those without epilepsy.1,2

All told, the first study, MONEAD, compared to a cohort of 89 women without epilepsy, a group of 294 with the seizure disorder breastfed their children at a rate of 19.5% lower. At 3 months postpartum, 59.2% of women with epilepsy were breastfeeding compared to 78.7% of those without (P = .004). Overall, both groups experienced a decrease in breastfeeding rates over time, as expected.1

Analysis from a second study, also presented at AES 2019, revealed similar results for breastfeeding initiation and adherence rates among women with epilepsy. The retrospective study showed that 51% in the group with epilepsy (n = 102) compared to 87% in the control group (n = 113) breastfed postpartum. At 6 weeks and 3 months, those rates decline to 38.2% and 36.2% for those with epilepsy, respectively, and dropped even further to 18.6% at 6 months.2

Some of this challenge, authors from both studies noted, is due lack of education from nonspecialist healthcare workers, who may not be familiar with the evidence of the benefits and safety of breastfeeding in this patient population. They may, in some instances, advise against the practice due to beliefs about antiepileptic drug interactions with breastmilk, or disrupted sleep which might trigger seizure events.

“We need to understand and address the challenges women with epilepsy face beyond seizure control and medication management when they are being seen by various health care providers to ensure the best quality of life for them and their babies,” said the second study's lead author Abrar Al-Faraj, MD, instructor of neurology, Boston University Medical Center, in a statement.3 “The strong efforts to advocate for breastfeeding in the general population should include women with chronic diseases such as epilepsy.”
 
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The MONEAD data also suggested that women with epilepsy were less likely to provide any breastmilk during the first 3 months postpartum, or at 6 months. Although, the rates of exclusive breastfeeding were similar between groups, with 34.5% of those with epilepsy doing so compared to 28.6% of those without at 3 months.

“Most epilepsy experts agree that the known benefits of breastmilk outweigh the mostly theoretical risks of exposure to most AEDs,” MONEAD lead author Elizabeth E. Gerard, MD, associate professor of neurology, Northwestern University Feinberg School of Medicine, said in a statement. “Two prior studies have prospectively examined the effects of breastfeeding in women taking AEDs and neither found adverse effects of breastfeeding on outcomes at 3 years. The NEAD study, the precursor to our current study, followed the AED-exposed children to age 6 and found superior cognitive outcomes among those who were breastfed.”

Al-Faraj, and coauthor Trudy Pang, MD, assistant professor of neurology, Beth Israel Deaconess Medical Center, noted that women with poor seizure control are a vulnerable group with a great need for intervention—such as focused physician education and lactation consultation, among others—to improve rates of breastfeeding.

“A woman with epilepsy should always discuss her treatment and ask about breastfeeding with her neurologist to ensure safety, especially if she is taking more than 1 medication,” said Al-Faraj in a statement. “The neurologist can reassure women that in most cases breastfeeding is safe and should be encouraged.”

Al-Faraj and Pang detailed that further prospective investigations are needed to discover additional factors which may prevent the decision to initiate or adhere to breastfeeding. Their work attempted to identify reasons for not breastfeeding among women with epilepsy, reporting that these reasons were only known in 17.6% of those in the second study. Those reasons included the aforementioned fear of antiepileptic drug exposure through breast milk, recommendations by different providers (pediatricians and obstetricians) not to breastfeed, failed breastfeeding trials due to technical difficulties, and lack of milk supply.

Their results also revealed that discussions regarding breastfeeding occurred by their attending neurologist for 52.9% of women with epilepsy, with 91% reporting their epilepsy nurse conducting the conversation. Of the 66% of those who received obstetrical care at Beth Israel Deaconess Medical Center, only 13% received lactation consultation prior to giving birth in comparison to 58% of the healthy cohort.

Breastfeeding education by the neurologist was found to be significantly positively correlated with the decision to do so (P <.005) and its initiation (P <.05). Additionally, postpartum lactation consultation was also associated with significantly higher rates of breastfeeding initiation (P <.05), adherence at 6 weeks (P = .01), at 3 months (P = .01).

“Although women with epilepsy initiate breastfeeding at lower rates than those without epilepsy, our research suggests if they start breastfeeding, they are similarly successful at continuing,” said Gerard.

For more coverage of AES 2019, click here.
REFERENCES
1. Gerard E, Pennell P. Breastfeeding in women with epilepsy in the MONEAD study. Presented at: American Epilepsy Society 2019 Meeting; December 7–10; Baltimore, Maryland. Abstract 1.250.
2. Al-faraj A, Pang T. Factors affecting breastfeeding patterns in women with epilepsy. Presented at: American Epilepsy Society 2019 Meeting; December 7–10; Baltimore, Maryland. Abstract 1.246.
3. Breastfeeding Rates Significantly Lower in Women with Epilepsy, Studies Show Neurologist, Lactation Consultant Support Can Make a Difference [press release]. Baltimore, MD: American Epilepsy Society; Published December 7, 2019. Accessed December 7, 2019.