Breast Feeding Epilepsy Toddler Development By Amy Norton
NEW YORK (Reuters Health) - Despite concerns that breastfeeding while Mom is on epilepsy medication could hinder infants' cognitive development, a small study out Wednesday 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, reported in the journal Neurology, 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.
Much more work, they say, remains to be done.
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.
However, the new study gives them more information on which to base that decision.
The researchers followed 199 U.S. and UK 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 percent 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.
"I think this definitely provides some reassurance to parents," said Dr. Steven V. Pacia, director of the Comprehensive Epilepsy Center at Lenox Hill Hospital in New York.
However, Pacia, who was not involved in the study, added that while the work is a "good first step," it is just that. Some limitations of the study, he told Reuters Health, include the fact that the women involved were using only four of the many types of anti-seizure drugs used to treat epilepsy.
The 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, Pacia said, that different medications, when transmitted via breast milk, could differ in any effects they have on infants' cognitive development.
Dr. Kimford J. Meador, the lead researcher on the study, agreed that the findings represent an initial step in offering reassurance to parents.
More studies are needed, including ones that look at other epilepsy medications and other measures of children' cognitive function, as IQ is only one indicator, said Meador, a professor of neurology at Emory University School of Medicine in Atlanta.
In addition, he told Reuters Health, it would be useful for studies to collect breast milk samples and infant blood samples to measure how much of a mother's medication is actually transmitted to her baby during breastfeeding.
All of that said, once a woman on an anti-seizure medication is informed of the benefits of breastfeeding and the theoretical risks, if she wants to breastfeed, Meador would encourage her to do so.
By the same token, however, Pacia said that if a new mother is concerned about breastfeeding while on epilepsy medication, he would not push her to breastfeed.
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 fetus.) Two other medications - phenobarbital (Luminal) and phenytoin - should be limited during pregnancy as well.
In an earlier analysis of this same study group, Meador and his colleagues found that valproate use during pregnancy was linked to a 7- to 9-point reduction in children's IQ at the age of 3, relative to the other three drugs included in the current study.
In the newer report, however, breastfeeding while on valproate was not linked to any further IQ effects, Meador pointed out. He speculated that breastfeeding may expose infants to far lower doses of the medication compared with the amount of drug that crosses the placenta during pregnancy.
Another neurologist not involved in the study also expressed cautious optimism about the findings.
In an editorial published with the report, Dr. Autumn Klein of Brigham and Women's Hospital in Boston writes that the findings offer parents taking anti-seizure medications some reassurance that "breastfeeding will likely not affect their child's IQ."
"However," she cautions, "there is still no definitive answer."
There remains a "pressing need," Klein writes, for more information on individual epilepsy drugs and studies that follow children for longer periods.
The study was funded by the U.S. National Institutes of Health and the UK Epilepsy Research Foundation. Meador and his colleagues on the work have received research support or served as consultants to various makers of epilepsy drugs.
SOURCE: http://link.reuters.com/kus33q Neurology, online November 24, 2010. Reuters Health
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