Clinical predictors for breastfeeding initiation among women with epilepsy

To study breastfeeding initiation and continuation rates and identify clinical predictors of breastfeeding initiation related to maternal epilepsy and the newborn's condition among women with epilepsy (WWE).

Data on a cohort of 1195 pregnant WWE from an epilepsy center in Poland from 2000 to 2019 were prospectively collected. Mann-Whitney U and ch2 tests -based comparisons between lactating and non-lactating WWE according to age, week of delivery, Apgar score, birth weight, type of epilepsy, seizure control, major congenital malformation (MCM), mode of delivery, type and dose of antiseizure medication (ASM) were performed. A logistic regression model was constructed to identify predictors of breastfeeding initiation.

Among 921 WWE, who gave birth to a living child, 709 (77%) initiated breastfeeding. The annual rate did not significantly change over the study period. Higher breastfeeding initiation rates were associated with vaginal birth (OR = 0.66) and lack of MCM (OR = 0.23). Breastfeeding initiation was less frequent with old-generation ASM monotherapy (OR = 0.36) or polytherapy (OR = 0.33) compared to no ASM treatment. The rate of breastfeeding initiation was positively associated with gestational week and the newborn's condition. At 6 months, about 1/3 of WWE maintained lactation.

Approximately ¾ of the WWE cohort initiated breastfeeding. Breastfeeding initiation was associated with delivery mode, treatment type, and the newborn's condition but was not associated with seizures during pregnancy or the individual ASM dose. Further studies are needed to identify additional factors that may negatively affect breastfeeding.