Safety of newer antiepileptics in infants exposed through breast milk as measured by infant growth parameters
Purpose: Management of women with epilepsy requires an optimal balance to minimize the risk of fetal and neonatal exposure to antiepileptics (AEDs), and of seizures, during pregnancy and the postpartum period. Despite the benefits of breastfeeding, concerns about the safety of breastfeeding while on antiepileptic therapy are usually raised. Older AEDs such as phenytoin, carbamazepine and valproate are deemed compatible with breastfeeding. There is limited data on the development of nursing infants of women on newer AEDs. This study aims to compare the growth parameters between the infants nursing from mothers on antiepileptic medications and infants nursing from unmedicated mothers.
Methods: Patients on antieptileptic monotherapy (N=37) and controls (N=41) were enrolled from the Australian Pregnancy Registry and two private obstetrician clinics respectively. Telephone interviews were conducted for demographic data, epilepsy history and antiepileptic drug regimen. Infant growth parameters (weight, height, head circumference) were monitored at birth, 2 months and 4 months.
Results: Interim data analysis does not support a difference in mean growth parameters for infants nursing from mothers taking either ‘newer’ or ‘older’ antiepileptic drugs, as compared with infants nursing from unmedicated mothers. No clinically significant effect was observed in mean growth parameters when compared with World Health Organisation data.
Conclusion: This study is helping to clarify some of the issues pertaining to the well being of nursing infants of mothers taking antiepileptic medications. No significant adverse effect on growth has thus far been observed in the nursing infants. Enrolment continues, and maternal postnatal depression scores and infant behaviour scores will also be analysed.
