Pregnancy, Breastfeeding and Epilepsy

Antiepileptic medications during pregnancy but not breastfeeding affect children

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Pregnant women with a chronic condition must balance the benefits of medication with the possible risks to their child. This is true especially for women with epilepsy.

Medications used to treat epilepsy are known to have some possibly harmful effects on unborn babies.

The researchers found that children of women taking anti-epileptic medications during pregnancy had poorer fine motor skills and social skills.

However, those medications do not appear to harm babies who are breastfeeding while their mothers take the medications.

"Discuss medications during pregnancy with your OB/GYN."

The study, led by Gyri Veiby, MD, of the Department of Clinical Medicine in the Section for Neurology at University of Bergen in Norway, looked at two sets of possible effects from anti-epileptic drugs.

First, the researchers wanted to know whether babies showed delayed development in their first few months if their mothers had taken anti-epileptic medications during pregnancy.

Then the researchers wanted to know whether babies appeared affected by anti-epileptic medications if mothers took them while breastfeeding.

The researchers tracked 78,744 mothers from when they were 13 to 17 weeks pregnant until their children were 6 months old.

Then the researchers followed up with 61,351 of the women when their children were 18 months old, and then with 44,147 of the women when their children were 3 years old.

At each follow-up involving their children, the mothers reported on their child's motor skills, social skills, language and behavior with standardized assessments.

The mothers also provided information about their breastfeeding during the first year after giving birth.

The researchers adjusted their analysis to account for the mother's age, number of previous children, education level, smoking status, presence of depression or anxiety, use of folate or folic acid supplements during pregnancy and amount of breastfeeding. The researchers also adjusted for children's birth defects.

The children of the 223 mothers who took anti-epileptic medications (while pregnant and after giving birth) were more likely to have difficulties with fine motor skills than the other children in the study.

Fine motor skills refer to the use of small muscles in the hands and feet in skills such as drawing or hand-eye coordination activities.

While 11.5 percent of the children of mothers who took anti-epileptics had impaired fine motor skills, only 4.8 percent of the other children had impaired fine motor skills.

For mothers using multiple anti-epileptics, a higher percentage of their children — 25 percent — had impaired fine motor skills.

In addition, these children also had a higher risk for delayed or impaired social skills compared to the children of mothers not taking any anti-epileptics.

While 10.2 percent of the overall children in the sample (not exposed to anti-epileptics) had impaired social skills, 22.5 percent of children whose mothers took multiple anti-epileptics had impaired social skills.

However, the researchers found that the children of women using anti-epileptics gained a benefit if they were breastfed for longer, at first.

"Continuous breastfeeding in children of women using anti-epileptic drugs was associated with less impaired development at ages 6 and 18 months compared with those with no breast-feeding or breastfeeding for less than 6 months," the researchers wrote.

Yet the protective effect wore off by the time the children were 3 years old.

"At 36 months, prenatal anti-epileptic drug exposure was associated with adverse development regardless of breastfeeding status during the first year," the researchers wrote.

"Children of women with epilepsy who did not use anti-epileptic drugs and children of fathers with epilepsy had normal development at 6 months," they wrote.

The researchers therefore concluded that children experienced impairments in fine motor skills at 6 months old if they had been exposed to anti-epileptic medications in the womb, especially if their mother used multiple kinds of anti-epileptics.

Yet breastfeeding while taking anti-epileptics did not show any harmful effects in the children.

"Women with epilepsy should be encouraged to breastfeed their children irrespective of anti-epileptic drug treatment," the researchers wrote.

Josephine Dlugopolski-Gach, MD, a pediatrician and internist at Loyola University Health System, said the study has left out some important details, though.

"The study does not mention what drugs were in the study and if there was a difference to the baby as to which drugs were used," she said.  "Breastfeeding is always encouraged, but the study does show that by age 3 any protective benefits of breastfeeding were gone.

Dr. Dlugopolski-Gach suggested that uncontrolled epilepsy can have damaging effects as well.

"The study does not mention the harmful effects to the child if the mother's epilepsy is uncontrolled," she said. "It is very important for the pregnant woman to talk to her OB and Neurologist to make sure that she is on the best possible regimen to ensure that she will have an uneventful pregnancy."

The study was published September 23 in the journal JAMA Neurology. The research was funded by the Norwegian Association for Epilepsy, the Norwegian Ministry of Health, the Norwegian Ministry Education and Research, the National Institute of Environmental Health Sciences, the National Institute of Neurological Disorders and Stroke and the Norwegian Research Council.

One author has received travel funds from UCB Pharm and lecture fees from GlaxoSmithKline. Another author has received travel funds from GlaxoSmithKline and lecture fees from Lundbeck. No other potential conflicts of interest were reported.

Review Date: 
September 23, 2013
Last Updated:
December 30, 2013