Antiseizure medication exposure in infants of breastfeeding mothers with epilepsy

Several studies have demonstrated that breastfeeding is safe for children of mothers who are taking an ASM. Breastfeeding has many short-term and long-term health benefits for mothers as well as for infant health, immunity, growth, and development. In the general population, the benefits of breastfeeding are widely documented and include nutritional benefits, protection against common childhood infections, and improved survival during the ۱st year, including a lower risk of Sudden Infant Death Syndrome. Thus, the American Academy of Pediatrics strongly advocates for breastfeeding and recommends exclusive breastfeeding of infants for the first ۶ months of life and continued breastfeeding for a year or longer with complementary food.Despite known health benefits, breastfeeding in women with epilepsy (WWE) face unique challenges: Breastfeeding safety in WWE has been debated for many years because of the scarcity of data on the degree of antiseizure medication (ASM) expression in breastmilk and short-and long-term infant health and developmental effects of ASM exposure related to breastfeeding. Exposure to ASMs via breastmilk and the lack of clear guidelines for breastfeeding recommendations in WWE lead to variable practices in breastfeeding education, and as well as dissuasion by some clinicians, due to safety concerns.Two studies in WWE showed no increased risk for poor cognitive outcomes at ۳ years old and one study showed improved verbal outcomes at age ۶ years old in infants that were breastfed.It is important to counsel postpartum women that the benefits of breastfeeding outweigh the risks; however, certain precautions should be kept in mind. Awakening several times at night in order to feed the baby will cause sleep disruption that could lead to increased seizure frequency. We encourage family and friends to help with nighttime feedings so that the mother can get an uninterrupted ۶–۸ h of sleep.