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Epilepsy and recommendations for breastfeeding.
Seizure 2015; 28:57-65S

Abstract

PURPOSE

The objective of this paper is to provide a synopsis of benefits and potential harmful effects of exposure to antiepileptic drugs (AEDs) via breastmilk, and present recommendations for breastfeeding in women with epilepsy.

METHODS

The article is based on a discretionary selection of English language articles retrieved by a literature search in the PubMed database, the LactMed database, and the authors' clinical experience.

RESULTS

Breastfeeding is associated with benefits for the infant, including nutrition, protection against infectious and immunological disease, and promotion of development and psychological attachment. Exposure to AEDs via breastmilk could potentially produce side effects or negatively affect development. Most studies on AED transfer through breastmilk report infant serum levels well below the limit of an expected pharmacological effect. Some drugs have the potential to reach significant serum levels in breastfed infants, such as barbiturates, benzodiazepines, lamotrigine, and ethosuximide. Thus, breastfed infants should be monitored for side effects. Still, adverse symptoms are rarely reported in breastfed infants of mothers taking AEDs, and prospective studies have failed to demonstrate any negative developmental effects in children that have been exposed to AEDs via breastmilk. The nursing infant's degree of drug exposure can be minimized by breastfeeding when drug concentrations in the milk are low, reducing maternal AED dosage to prepregnancy levels, and administering mixed nutrition.

CONCLUSION

Most AEDs are considered safe or moderately safe during breastfeeding. Mothers with epilepsy should be encouraged to breastfeed, provided careful monitoring of the infant.

Authors+Show Affiliations

Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Section for Neurology, University of Bergen, Norway. Electronic address: gyri.veiby@hotmail.com.Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Section for Neurology, University of Bergen, Norway.Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Section for Neurology, University of Bergen, Norway.Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Section for Neurology, University of Bergen, Norway.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

25837494

Citation

Veiby, Gyri, et al. "Epilepsy and Recommendations for Breastfeeding." Seizure, vol. 28, 2015, pp. 57-65.
Veiby G, Bjørk M, Engelsen BA, et al. Epilepsy and recommendations for breastfeeding. Seizure. 2015;28:57-65.
Veiby, G., Bjørk, M., Engelsen, B. A., & Gilhus, N. E. (2015). Epilepsy and recommendations for breastfeeding. Seizure, 28, pp. 57-65. doi:10.1016/j.seizure.2015.02.013.
Veiby G, et al. Epilepsy and Recommendations for Breastfeeding. Seizure. 2015;28:57-65. PubMed PMID: 25837494.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Epilepsy and recommendations for breastfeeding. AU - Veiby,Gyri, AU - Bjørk,Marte, AU - Engelsen,Bernt A, AU - Gilhus,Nils Erik, Y1 - 2015/03/16/ PY - 2014/10/27/received PY - 2015/01/27/revised PY - 2015/02/10/accepted PY - 2015/4/4/entrez PY - 2015/4/4/pubmed PY - 2016/1/28/medline KW - Antiepileptic drugs KW - Breastfeeding KW - Epilepsy KW - Postnatal development KW - Side effects SP - 57 EP - 65 JF - Seizure JO - Seizure VL - 28 N2 - PURPOSE: The objective of this paper is to provide a synopsis of benefits and potential harmful effects of exposure to antiepileptic drugs (AEDs) via breastmilk, and present recommendations for breastfeeding in women with epilepsy. METHODS: The article is based on a discretionary selection of English language articles retrieved by a literature search in the PubMed database, the LactMed database, and the authors' clinical experience. RESULTS: Breastfeeding is associated with benefits for the infant, including nutrition, protection against infectious and immunological disease, and promotion of development and psychological attachment. Exposure to AEDs via breastmilk could potentially produce side effects or negatively affect development. Most studies on AED transfer through breastmilk report infant serum levels well below the limit of an expected pharmacological effect. Some drugs have the potential to reach significant serum levels in breastfed infants, such as barbiturates, benzodiazepines, lamotrigine, and ethosuximide. Thus, breastfed infants should be monitored for side effects. Still, adverse symptoms are rarely reported in breastfed infants of mothers taking AEDs, and prospective studies have failed to demonstrate any negative developmental effects in children that have been exposed to AEDs via breastmilk. The nursing infant's degree of drug exposure can be minimized by breastfeeding when drug concentrations in the milk are low, reducing maternal AED dosage to prepregnancy levels, and administering mixed nutrition. CONCLUSION: Most AEDs are considered safe or moderately safe during breastfeeding. Mothers with epilepsy should be encouraged to breastfeed, provided careful monitoring of the infant. SN - 1532-2688 UR - https://www.unboundmedicine.com/medline/citation/25837494/Epilepsy_and_recommendations_for_breastfeeding_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1059-1311(15)00041-2 DB - PRIME DP - Unbound Medicine ER -