Breastfeeding and Subsequent Neuropsychological Outcomes at Age 6-Years-Old in the MONEAD Study
Kimford Meador1, YI Li1, Morris Cohen2, David Loring3, Abigail Matthews4, Page Pennell5
1Neurology & Neurological Sciences, Stanford University School of Medicine, 2Pediatric Neuropsychology International, 3Neurology, Emory Univ, Dept of Neurology, 4The Emmes Company, LLC, 5Neurology, University of Pittsburgh School of Medicine
Objective:
To assess the relation of breastfeeding and subsequent 6-year-old neuropsychological outcomes in children of women with epilepsy (WWE) and healthy women (HW).
Background:
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.
Design/Methods:
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.
Results:
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)).
Conclusions:
Breastfeeding in WWE on ASMs is not associated with adverse verbal or behavioral outcomes in their children at age 6 years old.
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