To assess the relation of breastfeeding and subsequent 6-year-old neuropsychological outcomes in children of women with epilepsy (WWE) and healthy women (HW).

Breastfeeding is known to have multiple positive health benefits for both mothers and children, but concerns have been raised over antiseizure medication (ASM) exposure during breastfeeding.

The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study was a prospective, observational, multi-center investigation which enrolled WWE and HW during pregnancy. The a priori primary neurodevelopmental outcome for children is age 6 Verbal Index score (VIS) calculated by averaging Differential Ability Scales-II Word Definitions and Verbal Similarities subtests, Expressive One-Word Picture Vocabulary Test-4, Peabody Picture Vocabulary Test-4, and Neuropsychological Assessment-2 Phonological Processing, Comprehension of Instructions, and Sentence Repetition subtests. The main behavioral outcome is the Adaptive Behavior Assessment System (ABAS-3) General Adaptive Composite Standard Score (GAC). We compared these outcomes in children of WWE on ASMs vs HW who breastfeed using linear regression adjusting for potential confounders chosen via a stepwise selection algorithm.

Breastfeeding occurred in 77.1% of WWE and 92.5% of HW. Analyses include children of WWE (n=202) and HW (74). The majority of WWE were on lamotrigine or levetiracetam. For adjusted VIS, mean adjusted score was 108.34, 95% CIs (107.50, 109.19) in children of WWE, and was 108.45, 95% CIs (107.19, 109.71) for children of HW, which did not differ (p-value = 0.89, 95% CIs difference (-1.39, 1.60)). For adjusted ABAS GAC score, mean adjusted score was 102.28, 95% CIs (101.76, 102.79) for children of WWE, and 102.44, 95% CI (102.03, 102.85) for children of WWE, which did not differ (p-value = 0.63, 95% CI for difference (-0.49, 0.81)).

Breastfeeding in WWE on ASMs is not associated with adverse verbal or behavioral outcomes in their children at age 6 years old.