Breastfeeding During Antiseizure Treatment Not Linked to Adverse Development at Age 6

Breastfeeding while taking contemporary antiseizure medications (ASMs) was not associated with adverse neurodevelopmental outcomes at age 6 years in children of women with epilepsy (WWE), according to a cohort study published in JAMA Network Open.

The investigators noted that concerns about infant ASM exposure through breast milk frequently discourage breastfeeding in WWE. The analysis used data from the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study, a prospective, observational cohort study conducted at 20 US epilepsy centers. Pregnant WWE and healthy pregnant women were enrolled from December 2012 to October 2016, and children were followed up to age 6 years. Children's ASM exposure was primarily to levetiracetam and lamotrigine.

The primary outcomes were verbal language, measured by the Verbal Index Score, and adaptive behavior, measured by the General Adaptive Composite score of the Adaptive Behavior Assessment System, Third Edition. Among breastfed children, adjusted scores did not differ significantly between children of WWE and children of healthy women for verbal language (difference, 0.75; 95% CI, −2.40 to 3.89) or adaptive behavior (difference, 0.78; 95% CI, −2.52 to 4.07). The language analysis included 262 children of WWE and 80 children of healthy women.

Within the WWE cohort, breastfeeding for 6 months or longer was associated with higher adaptive behavior scores than no breastfeeding (estimate, 4.68; 95% CI, 1.34 to 8.03). The difference was driven by the practical and conceptual subdomains, while durations shorter than 6 months did not differ. The association remained significant in the pooled monotherapy group but not in the polytherapy group. Breastfeeding duration was not significantly associated with verbal language outcomes.

The authors concluded that the findings support clinical recommendations for extended breastfeeding (≥6 months) in WWE. They said residual confounding cannot be excluded and that subgroup analyses by ASM regimen are likely underpowered. They also noted a lack of data on whether breastfeeding was exclusive. Because recruitment was mainly at specialized tertiary epilepsy centers, the findings may not apply as well to patients treated in general or rural community practices.

Source: Li Y, Loring DW, Cohen MJ, et al. Breastfeeding and neurodevelopmental outcomes in children of women taking antiseizure medications. JAMA Netw Open. 2026;9(9):e2637040. doi:10.1001/jamanetworkopen.2026.37040