Epilepsy Curr. 2015 Jan-Feb;15(1):10-2.
The benefits of breastfeeding continue to be discovered. The current guidelines of the American Academy of Pediatrics recommend breast milk as the primary source of nutrition for the first 6 months and as a supplement for at least the first year. Breastfeeding has been shown to reduce the incidence of infections, autoimmune disorders, sudden infant death syndrome (SIDS), and infant mortality. The greatest benefits were observed in children breastfed for more than 6 months, but any human milk is beneficial. Multiple studies associate breast-feeding with increased cognition, specifically verbal cognition, in preschool and school-age children. However, breastfeeding can be contraindicated in some cases, such as an infant with a metabolic disorder or maternal infections, or maternal medications that may be harmful.
For the case of AEDs, the safety of breastfeeding has been unclear, and the option was often discouraged by primary care physicians and pediatricians. The main concern is the level of AED(s) in the breast milk and the overall dose the infant will receive. Unlike in utero exposure, in which the fetal levels are similar to maternal plasma concentrations, AEDs are differentially secreted into human milk. Phenytoin and valproate are considered safe due to very low concentrations found in milk. By contrast, the levels of levetiracetam in breast milk are high and may be equivalent to a therapeutic dose. Therefore, a mother with epilepsy and her health care team are faced with the conundrum of whether the benefits of breastfeeding will overcome the potential harm due to the possible AED exposure.