Highlights
- •A total of 15 articles reporting on antiseizure medications (ASMs) in human milk were systematically reviewed.
- •The calculated relative infant doses were less than 10% for the majority of the ASMs.
- •Breastfeeding might be limited or discontinued in case of excessive sedation/drowsiness and/or poor weight gain.
Abstract
Background
Recent position papers and guidelines encourage women with epilepsy (WWE) to exclusively
breastfeed their infants because the benefits to their infants outweigh the potential
adverse effects caused by exposure to antiseizure medications (ASMs).
Objective
The objectives of this review were: to evaluate concentrations of ASMs in breastmilk
of lactating WWE, qualitatively synthesize evidence that can be used to estimate theoretical
doses as estimated daily intake (EDI) and relative infant dose (RID) of ASMs, and
to evaluate potential risks to infants as a result of exposure to ASMs from breastmilk.
Methods
This systematic review was registered in the International Prospective Register of
Systematic Reviews (PROSPERO) as CRD42020223645. The databases: MEDLINE/PubMed, EMBASE,
CINAHL/EBSCO, COCHRANE, SpringerLink, ScienceDirect, Summon, WHO International Clinical
Trials Registry Platform, and SCOPUS were systematically searched. A qualitative synthesis
was adopted in this study.
Results
A total of 15 records were included in this systematic review. The included studies
reported levels of 8 ASMs in the breastmilk of WWE. The highest RIDs of carbamazepine,
lamotrigine, primidone, phenobarbital, gabapentin, valproic acid, ethosuximide, levetiracetam,
and topiramate were 3.70%, 36.33%, 4.96%, 3.15%, 4.37%, 1.90%, 31.49%, 12.50%, and
12.18%, respectively. Breastfeeding might be limited or even discontinued when signs
of excessive sedation/drowsiness and/or poor weight gain are evident on infants exposed
to primidone and phenobarbital, ethosuximide/primidone, or ethosuximide/phenobarbital.
Conclusions
Concentrations of ASMs can be detected in breastmilk of WWE and plasma/serum of infants
exposed via breastmilk. Healthcare providers and WWE might use the findings of this study to
make informed decisions on the safety of breastfeeding while taking ASMs.
Keywords
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Article info
Publication history
Published online: March 27, 2022
Accepted:
March 25,
2022
Received in revised form:
March 20,
2022
Received:
December 25,
2021
Identification
Copyright
© 2022 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
