Several Factors May Lead to Lower Breastfeeding Rates in Women With Epilepsy

Poor seizure control, lack of breastfeeding education from a neurologist or lactation consultant, are factors contributing to lower breastfeeding rates in women with epilepsy, compared with the general population, according to study results presented at the American Epilepsy Society 2019 Annual Meeting, held in Baltimore, Maryland from December 6 to 10.

Previous studies have stressed the benefits of breastfeeding in the general population. Studies focusing on women with epilepsy have pointed to possible benefits of breastfeeding in children born to women with epilepsy, but have suggested lower rates of initiation and adherence of breastfeeding in this population.¹

Results of the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study,² also presented at the American Epilepsy Society 2019 Annual Meeting, have supported these findings. The study enrolled 294 women with epilepsy and 89 women without epilepsy. At 3 months postpartum, women with epilepsy were less likely to breastfeed their infants, compared with women without epilepsy (59.2% vs 78.7%; P=.004). Women with epilepsy were also less likely to provide any breastmilk between 0 and 3 months postpartum or at the 6-month postpartum visit.

The study conducted by Al-faraj and colleagues² aimed to assess the rate of breastfeeding in women with epilepsy, compared with healthy controls, identify factors affecting breastfeeding in women with epilepsy and explore the importance of support system on breastfeeding.

This retrospective study included 102 women with epilepsy who underwent pregnancies, as well as 113 healthy controls, all treated at the Beth Israel Deaconess Medical center between 2009 and 2018.

At the child’s birth, 51% of women with epilepsy initiated breastfeeding, compared with 87% of those without epilepsy. At 6 weeks, rate of breastfeeding was 2-fold higher in the group of women without epilepsy, compared with women with epilepsy (76% vs 38.2%, respectively).²

The most commonly identified reasons for not breastfeeding included fear of antiepileptic drug exposure through breast milk, physician’s recommendation to avoid breastfeeding, technical difficulties leading to failed attempts to breastfeed, and lack of milk supply. Al-faraj and colleagues also noted that women with epilepsy were much less likely to receive consultation on breastfeeding after birth.

Factors associated with increased adherence of breastfeeding included education by the treating neurologist, and postpartum lactation consultant, as 37% of women with epilepsy who received education from their neurologist initiated breastfeeding, as did 77% of those who had a lactation consultation.³ Furthermore, seizure control was another important factor associated with adherence of breastfeeding.

In a press release, Abrar Al-Faraj MD, instructor of neurology at Boston University School of Medicine, and lead author of one of the aforementioned studies, highlighted that, “A woman with epilepsy should always discuss her treatment and ask about breastfeeding with her neurologist to ensure safety, especially if she is taking more than one medication.”

Reference

1. Al-faraj A, Pang T. Factors affecting breastfeeding patterns in women with epilepsy. Presented at The American Epilepsy Society 2019 Annual Meeting; December 6-10, 2019; Baltimore, MD. Abstract 1.246.

2. Gerard E, Pennel P. Breastfeeding in women with epilepsy in the MONEAD study. Presented at The American Epilepsy Society 2019 Annual Meeting; December 6-10, 2019; Baltimore, MD. Abstract 1.250.

3. Breastfeeding rates significantly lower in women with epilepsy, studies show neurologist, lactation consultant support can make a difference [news release]. Baltimore, MD: American Epilepsy Society; December 7, 2019. Accessed December 6, 2019.