Breastfeeding and Neurodevelopmental Outcomes in Children of Women Taking Antiseizure Medications

@article{li2026breastfeeding,
  title = {{Breastfeeding and Neurodevelopmental Outcomes in Children of Women Taking Antiseizure Medications}},
  author = {Yi Li and David W. Loring and Morris J. Cohen and Elizabeth E. Gerard and Angela K. Birnbaum and Abigail G. Matthews and Page B. Pennell and Kimford J. Meador and MONEAD Investigator Group and Maurice Druzin and Richard Finnell and Gregory Holmes and Frederick T. McElrath and Lorene Nelson and Zachary Stowe and Linda Van Marter and Peter Wells and Mark Yerby and Eugene Moore and Ryan May and Dominic Ippolito and Lisa Davis and Nilay Shah and Brenda Leung and Mark Friedman and Traci Sheer and Yue Wang and Suzanne Strickland and Erin Latif and Yong Park and Delmaris Acosta-Cotte and Patty Ray and Kirsten Cleary and Joyce Echo and Annette Zygmunt and Camilla Casadei and Mary Dolan and Kim Ono and Donald Bearden and Christine Ghilian and Diane Teagarden and Melanee Newman and Paul McCabe and Michael Paglia and Rosemarie Delucca and Kristina Blessing and Katrina Boyer and Ellen Hanson and Amy Young and Paige Hickey and Jolie Strauss and Hayley Madeiros and Li Chen and Stephanie Allien and Yvonne Sheldon and Taylor Weinau and Elizabeth Shashkova and Melanie Choe and Gregory L. Barkley and Marianna Spanaki-Varelas},
  journal = {JAMA Network Open},
  year = {2026},
  month = sep,
  doi = {10.1001/jamanetworkopen.2026.37040},
  url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2854645},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Breastfeeding and Neurodevelopmental Outcomes in Children of Women Taking Antiseizure Medications
AU  - Yi Li
AU  - David W. Loring
AU  - Morris J. Cohen
AU  - Elizabeth E. Gerard
AU  - Angela K. Birnbaum
AU  - Abigail G. Matthews
AU  - Page B. Pennell
AU  - Kimford J. Meador
AU  - MONEAD Investigator Group
AU  - Maurice Druzin
AU  - Richard Finnell
AU  - Gregory Holmes
AU  - Frederick T. McElrath
AU  - Lorene Nelson
AU  - Zachary Stowe
AU  - Linda Van Marter
AU  - Peter Wells
AU  - Mark Yerby
AU  - Eugene Moore
AU  - Ryan May
AU  - Dominic Ippolito
AU  - Lisa Davis
AU  - Nilay Shah
AU  - Brenda Leung
AU  - Mark Friedman
AU  - Traci Sheer
AU  - Yue Wang
AU  - Suzanne Strickland
AU  - Erin Latif
AU  - Yong Park
AU  - Delmaris Acosta-Cotte
AU  - Patty Ray
AU  - Kirsten Cleary
AU  - Joyce Echo
AU  - Annette Zygmunt
AU  - Camilla Casadei
AU  - Mary Dolan
AU  - Kim Ono
AU  - Donald Bearden
AU  - Christine Ghilian
AU  - Diane Teagarden
AU  - Melanee Newman
AU  - Paul McCabe
AU  - Michael Paglia
AU  - Rosemarie Delucca
AU  - Kristina Blessing
AU  - Katrina Boyer
AU  - Ellen Hanson
AU  - Amy Young
AU  - Paige Hickey
AU  - Jolie Strauss
AU  - Hayley Madeiros
AU  - Li Chen
AU  - Stephanie Allien
AU  - Yvonne Sheldon
AU  - Taylor Weinau
AU  - Elizabeth Shashkova
AU  - Melanie Choe
AU  - Gregory L. Barkley
AU  - Marianna Spanaki-Varelas
PY  - 2026
DA  - 2026/09/30
JO  - JAMA Network Open
DO  - 10.1001/jamanetworkopen.2026.37040
UR  - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2854645
AB  - Importance: Concerns regarding infant exposure to antiseizure medications (ASMs) via breast milk frequently discourage breastfeeding in women with epilepsy (WWE). Longitudinal neurodevelopmental data for breastfeeding while taking contemporary ASM regimens are essential for evidence-based management.  Objective: To evaluate the association between breastfeeding duration and neurodevelopmental outcomes at age 6 years in children exposed to contemporary ASM regimens.  Design, Setting, and Participants: The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs study is a prospective, multicenter, cohort study. Pregnant WWE and healthy pregnant women were enrolled from December 2012 to October 2016, with children followed up to age 6 years. Children’s outcomes were analyzed between January 2023 and December 2024.  Exposures: Breastfeeding duration (none, <6 months, ≥6 months) and children’s exposure to contemporary ASMs (primarily levetiracetam and lamotrigine).  Main Outcomes and Measures: The primary outcomes at child age 6 years included verbal language (Verbal Index Score) and adaptive behavior (General Adaptive Composite score in Adaptive Behavior Assessment System Scale).  Results: A total of 273 children of WWE (median [range] maternal age, 31.0 [19.0-46.0] years; 127 [46.5%] male) and 84 children of healthy women (median maternal age, 31.0 [15.0-38.0] years; 47 [56.0%] male) were included, with 262 children of WWE and 80 children of healthy women in the language outcome sample and 261 children of WWE and 83 children of healthy women in the behavioral outcome set. Adjusted mean (SD) verbal language (107.93 [0.71] vs 107.18 [1.40]; difference, 0.75; 95% CI, −2.40 to 3.89; P = .64) and adaptive behavior (102.91 [0.75] vs 102.14 [1.46]; difference, 0.78; 95% CI, −2.52 to 4.07; P = .64) outcomes did not significantly differ between groups. Within the WWE cohort, breastfeeding for 6 months or longer was significantly associated with higher adaptive behavioral scores compared with no breastfeeding (estimate, 4.68; 95% CI, 1.34 to 8.03; P = .01), driven by practical and conceptual subdomains; whereas shorter durations (<6 months) did not differ. Neurodevelopmental outcomes were comparable within each specific ASM regimen—including levetiracetam, lamotrigine, other monotherapy, and polytherapy—regardless of breastfeeding duration. Notably, the benefit associated with breastfeeding for 6 months or longer remained significant in the pooled monotherapy group (difference, 5.88; 95% CI, 2.21 to 9.55; P = .001) but not in the polytherapy group.  Conclusions and Relevance: In this cohort study of children born to WWE, breastfeeding while taking contemporary ASM regimens was not associated with adverse neurodevelopmental outcomes at age 6 years. The observed improved adaptive behavioral outcome supports clinical recommendations for extended breastfeeding (≥6 months) in WWE.
SN  - 2574-3805
ER  -