Related Experiment Video
Updated: Dec 31, 2025
Application of an Amplitude-integrated EEG Monitor Cerebral Function Monitor to Neonates
Published on: September 6, 2017
Antiepileptic Drug Exposure in Infants of Breastfeeding Mothers With Epilepsy
Angela K Birnbaum1, Kimford J Meador2, Ashwin Karanam1
1Experimental & Clinical Pharmacology, University of Minnesota, Minneapolis.
Insights
Breastfeeding infants whose mothers take antiepileptic drugs (AEDs) results in substantially lower infant blood concentrations. These findings support breastfeeding for mothers with epilepsy on AED therapy, highlighting the benefits of breastfeeding.
Area of Science:
- Pharmacology
- Pediatrics
- Neurology
Background:
- Limited data exists on infant exposure to antiepileptic drugs (AEDs) through breastfeeding.
- Maternal epilepsy treatment often requires AEDs, raising concerns about infant exposure via breast milk.
Purpose of the Study:
- To quantify antiepileptic drug (AED) exposure in breastfed infants.
- To provide objective data on infant-to-mother drug concentration ratios.
Main Methods:
- Prospective cohort study (MONEAD) involving 351 mothers with epilepsy and their 345 infants.
- Collected blood samples from mothers and infants to measure AED concentrations.
- Assessed breastfeeding duration and infant milk intake.
Main Results:
- Of 345 infants, 222 (64.3%) were breastfed.
- Approximately 49% of infant AED concentrations were below the limit of quantification.
- Median infant-to-mother concentration ratios varied widely by AED, ranging from 0.3% to 44.2%.
Conclusions:
- Breastfed infants generally had substantially lower AED blood concentrations than their mothers.
- Findings support breastfeeding for mothers with epilepsy on AED therapy.
- Benefits of breastfeeding are emphasized, with prior studies showing no adverse effects.
Importance:
There is limited information on infant drug exposure via breastfeeding by mothers who are receiving antiepileptic drug therapy.
Objective:
To provide direct, objective information on antiepileptic drug exposure through breast milk.
Design, Setting, And Participants:
This prospective cohort study was conducted between December 2012 to October 2016, with follow-up in children until 6 years of age at 20 sites across the United States. Data were collected via an observational multicenter investigation (Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs [MONEAD]) of outcomes in pregnant mothers with epilepsy and their children. Pregnant women with epilepsy who were aged 14 to 45 years, had pregnancies that had progressed to less than 20 weeks' gestational age, and had measured IQ scores of more than 70 points were enrolled and followed up through pregnancy and 9 postpartum months. Their infants were enrolled at birth. Data were analyzed from May 2014 to August 2019.
Exposures:
Antiepileptic drug exposure in infants who were breastfed.
Main Outcomes And Measures:
The percentage of infant-to-mother concentration of antiepileptic drugs. Antiepileptic drug concentrations were quantified from blood samples collected from infants and mothers at the same visit, 5 to 20 weeks after birth. Concentrations of antiepileptic drugs in infants at less than the lower limit of quantification were assessed as half of the lower limit. Additional measures collected were the total duration of all daily breastfeeding sessions and/or the volume of pumped breast milk ingested from a bottle.
Results:
A total of 351 women (of 865 screened and 503 eligible individuals) were enrolled, along with their 345 infants (179 female children [51.9%]; median [range] age, 13 [5-20] weeks). Of the 345 infants, 222 (64.3%) were breastfed; the data collection yielded 164 matching infant-mother concentration pairs from 138 infants. Approximately 49% of all antiepileptic drug concentrations in nursing infants were less than the lower limit of quantification. The median percentage of infant-to-mother concentration for all 7 antiepileptic drugs and 1 metabolite (carbamazepine, carbamazepine-10,11-epoxide, levetiracetam, lamotrigine, oxcarbazepine, topiramate, valproate, and zonisamide) ranged from 0.3% (range, 0.2%-0.9%) to 44.2% (range, 35.2%-125.3%). In multiple linear regression models, maternal concentration was a significant factor associated with lamotrigine concentration in infants (Pearson correlation coefficient, 0.58; P < .001) but not levetiracetam concentration in infants.
Conclusions And Relevance:
Overall, antiepileptic drug concentrations in blood samples of infants who were breastfed were substantially lower than maternal blood concentrations. Given the well-known benefits of breastfeeding and the prior studies demonstrating no ill effects when the mother was receiving antiepileptic drugs, these findings support the breastfeeding of infants by mothers with epilepsy who are taking antiepileptic drug therapy.
More Related Videos
Related Concept Videos
01:20Antiepileptic Drugs: Potassium Channel Activators
Ezogabine has gained approval as an adjunctive treatment...
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:20Antiepileptic Drugs: Modulators of Neurotransmitter Release Mediated by SV2A Protein
SV2A is a transmembrane glycoprotein located predominantly in the brain, modulating the release of neurotransmitters for neuronal communication. Both levetiracetam and brivaracetam exhibit a high affinity for...
01:24Epilepsy and Seizures: Overview
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...
01:29Drug Dosing: Infants and Children
01:17Antiepileptic Drugs: Calcium Channel Blockers
Calcium channel blockers exert their antiepileptic effects by targeting T-type calcium channels, which are integral to transmitting nerve signals in the central nervous system. These channels allow the passage of calcium ions, which are vital for neuronal communication. By inhibiting T-type calcium channels, calcium channel blockers effectively reduce the release of neurotransmitters and...