Observational Study

. 2023 Nov 27;101(22):e2266-e2276.

doi: 10.1212/WNL.0000000000207812.

Initiation and Duration of Breastfeeding in the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs Study

Elizabeth E Gerard¹, Kimford J Meador², Chelsea P Robalino², Carrie Anne Brown², Abigail G Matthews², P Emanuela Voinescu², Laura A Kalayjian², Evan Gedzelman², Julie Hanna², Jennifer Cavitt², Maria Sam², Jacqueline A French², Alison M Pack², Sean T Hwang², Jeffrey J Tsai², Cora Taylor², Page B Pennell²; MONEAD Investigator Study Group

Collaborators, Affiliations

Collaborators

MONEAD Investigator Study Group:
Ryan May, Angela Birnbaum, Morris Cohen, Maurice Druzin, Richard Finnell, Gregory Holmes, David W Loring, Frederick T McElrath, Lorene Nelson, Zachary Stowe, Linda Van Marter, Peter Wells, Mark Yerby, Eugene Moore, Dominic Ippolito, Yue Wang, Julia Skinner, Lisa Davis, Nilay Shah, Brenda Leung, Mark Friedman, Hayley Loblien, Traci Scheer, Nancy Browning, Michelle Arias, Rebecca Ayre, Temperance Blalock, Linda Hendrickson, Meghan Kelly Kunchai, Merin Mathew, Kaitlyn Menard, Anjali Nair, Yinka Ogunsola, Chinh Ott, Phyllis Zaia Renehan, Sarah Romano, Dominic Schutte, Noble Shore, Vydhi Vasudevan, Steffanie Wilson, Jamie Winestone, Thad Zajdowicz, Suzanne Strickland, Erin Latif, Yong Park, Delmaris Acosta-Cotte, Kirsten Cleary, Joyce Echo, Annette Zygmunt, Camilla Casadei, Ifemoa Irobunda, Anna Chessky, Mary Dolan, Kim Ono, Don Bearden, Christine Ghilian, Diane Teagarden, Melanee Newman, Yvan Bamps, Emilee Wehunt, Paul McCabe, Michael Paglia, Cora Taylor, Rosemarie Delucca, Kristina Blessing, Joshua Dopko, Katrina Boyer, Ellen Hanson, Amy Young, Paige Hickey, Jolie Strauss, Haley Maderios, Li Chen, Elizabeth Shashkova, Stephanie Allien, Yvonne Sheldon, Taylor Weinau, Gregory Barkley, Marianna Spanaki-Varelas, Andrea Thomas, Jules Constatinou, Nazin Mahmood, Vibhangini Wasade, Shailaja Gaddam, Andrew Zillgitt, Taimur Anwar, Carla Sandles, Theresa Holmes, Emily Johnson, Gregory Krauss, Shari Lawson, Alison Pritchard, Matthew Ryan, Pam Coe, Julia Hanna, Katie Reger, Jenny Pohlman, Alisha Olsen, Sarah Ellis, William Schweizer, Chris Morrison, William Macallister, Tobi Clements, Aaron Smith, Maria Pleshkovich, Sean Hwang, Hima Bindu Tam Tam, Yael Cukier, Erica Melzer, Jacqueline Helcer, Connie Lau, Scott Baron, Olivia Colon, William Grobman, Joseph Coda, Emily Miller, Irena Bellinski, Elizabeth Cunningham, Casey Krueger, Jordan Seliger, Jennifer DeWolfe, John Owen, Matthew Thompson, Cheryl Hall, Valencia Williams, Anna Moyana, David Labiner, James Maciulla, Jennifer Moon, Alicia Bahe, Kayla Darris, Michael Privitera, Kellie Flood-Schaffer, George Jewell, Becky McElroy, Lucy Mendoza, Naymee Velez-Ruiz, Yasin Salin, Gustavo Rey, Christina Bermudez, Michelle Miranda, Enrique Serrano, Pedro Figueredo, Kristin Ramirez, Anto Bagic, Alexandra Popescu Urban, Satya Gedela, Christina Patterson, Arundhathi Jeyablan, Krestin Radonovich, Melissa Sutcliffe, Susan Beers, Carrie Wiles, Sandra Alhaj, Sabrina Duran, Alice Stek, Sonia Perez, Cynthia Munoz, Rachel Sierra, John Miller, Jennie Mao, Vaishali Phatak, Michelle Kim, Andrea Cheng-Hakimian, Gina DeNoble, Erin Anthony-Fick, Jennifer Steele, Lamar Parker, Melissa Morris, Jessica Dimos, Deanna Oates, Danielle Culbreth

Affiliations

¹ From the Northwestern University (E.E.G.), Chicago, IL; Stanford University (K.J.M.), Palo Alto, CA; The Emmes Company, LLC, (C.P.R., C.A.B., A.G.M.), Rockville, MD; Harvard University (P.E.V.), Boston, MA; University of Southern California (L.A.K.), Los Angeles, CA; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (J.H.), Minneapolis, MN; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; New York University (J.A.F.); Columbia University (A.M.P.), New York, NY; Zucker School of Medicine at Hofstra Northwell (S.T.H.), Hempsted, NY; University of Washington (J.J.T.), Seattle, WA; Geisinger Medical Center (C.T.), Danville, PA; and University of Pittsburgh (P.B.P.), PA. e-gerard@northwestern.edu.
² From the Northwestern University (E.E.G.), Chicago, IL; Stanford University (K.J.M.), Palo Alto, CA; The Emmes Company, LLC, (C.P.R., C.A.B., A.G.M.), Rockville, MD; Harvard University (P.E.V.), Boston, MA; University of Southern California (L.A.K.), Los Angeles, CA; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (J.H.), Minneapolis, MN; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; New York University (J.A.F.); Columbia University (A.M.P.), New York, NY; Zucker School of Medicine at Hofstra Northwell (S.T.H.), Hempsted, NY; University of Washington (J.J.T.), Seattle, WA; Geisinger Medical Center (C.T.), Danville, PA; and University of Pittsburgh (P.B.P.), PA.

PMID: 37816636
PMCID: PMC10727216
DOI: 10.1212/WNL.0000000000207812

Observational Study

Initiation and Duration of Breastfeeding in the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs Study

Elizabeth E Gerard et al. Neurology. 2023.

. 2023 Nov 27;101(22):e2266-e2276.

doi: 10.1212/WNL.0000000000207812.

Authors

Collaborators

MONEAD Investigator Study Group:
Ryan May, Angela Birnbaum, Morris Cohen, Maurice Druzin, Richard Finnell, Gregory Holmes, David W Loring, Frederick T McElrath, Lorene Nelson, Zachary Stowe, Linda Van Marter, Peter Wells, Mark Yerby, Eugene Moore, Dominic Ippolito, Yue Wang, Julia Skinner, Lisa Davis, Nilay Shah, Brenda Leung, Mark Friedman, Hayley Loblien, Traci Scheer, Nancy Browning, Michelle Arias, Rebecca Ayre, Temperance Blalock, Linda Hendrickson, Meghan Kelly Kunchai, Merin Mathew, Kaitlyn Menard, Anjali Nair, Yinka Ogunsola, Chinh Ott, Phyllis Zaia Renehan, Sarah Romano, Dominic Schutte, Noble Shore, Vydhi Vasudevan, Steffanie Wilson, Jamie Winestone, Thad Zajdowicz, Suzanne Strickland, Erin Latif, Yong Park, Delmaris Acosta-Cotte, Kirsten Cleary, Joyce Echo, Annette Zygmunt, Camilla Casadei, Ifemoa Irobunda, Anna Chessky, Mary Dolan, Kim Ono, Don Bearden, Christine Ghilian, Diane Teagarden, Melanee Newman, Yvan Bamps, Emilee Wehunt, Paul McCabe, Michael Paglia, Cora Taylor, Rosemarie Delucca, Kristina Blessing, Joshua Dopko, Katrina Boyer, Ellen Hanson, Amy Young, Paige Hickey, Jolie Strauss, Haley Maderios, Li Chen, Elizabeth Shashkova, Stephanie Allien, Yvonne Sheldon, Taylor Weinau, Gregory Barkley, Marianna Spanaki-Varelas, Andrea Thomas, Jules Constatinou, Nazin Mahmood, Vibhangini Wasade, Shailaja Gaddam, Andrew Zillgitt, Taimur Anwar, Carla Sandles, Theresa Holmes, Emily Johnson, Gregory Krauss, Shari Lawson, Alison Pritchard, Matthew Ryan, Pam Coe, Julia Hanna, Katie Reger, Jenny Pohlman, Alisha Olsen, Sarah Ellis, William Schweizer, Chris Morrison, William Macallister, Tobi Clements, Aaron Smith, Maria Pleshkovich, Sean Hwang, Hima Bindu Tam Tam, Yael Cukier, Erica Melzer, Jacqueline Helcer, Connie Lau, Scott Baron, Olivia Colon, William Grobman, Joseph Coda, Emily Miller, Irena Bellinski, Elizabeth Cunningham, Casey Krueger, Jordan Seliger, Jennifer DeWolfe, John Owen, Matthew Thompson, Cheryl Hall, Valencia Williams, Anna Moyana, David Labiner, James Maciulla, Jennifer Moon, Alicia Bahe, Kayla Darris, Michael Privitera, Kellie Flood-Schaffer, George Jewell, Becky McElroy, Lucy Mendoza, Naymee Velez-Ruiz, Yasin Salin, Gustavo Rey, Christina Bermudez, Michelle Miranda, Enrique Serrano, Pedro Figueredo, Kristin Ramirez, Anto Bagic, Alexandra Popescu Urban, Satya Gedela, Christina Patterson, Arundhathi Jeyablan, Krestin Radonovich, Melissa Sutcliffe, Susan Beers, Carrie Wiles, Sandra Alhaj, Sabrina Duran, Alice Stek, Sonia Perez, Cynthia Munoz, Rachel Sierra, John Miller, Jennie Mao, Vaishali Phatak, Michelle Kim, Andrea Cheng-Hakimian, Gina DeNoble, Erin Anthony-Fick, Jennifer Steele, Lamar Parker, Melissa Morris, Jessica Dimos, Deanna Oates, Danielle Culbreth

Affiliations

¹ From the Northwestern University (E.E.G.), Chicago, IL; Stanford University (K.J.M.), Palo Alto, CA; The Emmes Company, LLC, (C.P.R., C.A.B., A.G.M.), Rockville, MD; Harvard University (P.E.V.), Boston, MA; University of Southern California (L.A.K.), Los Angeles, CA; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (J.H.), Minneapolis, MN; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; New York University (J.A.F.); Columbia University (A.M.P.), New York, NY; Zucker School of Medicine at Hofstra Northwell (S.T.H.), Hempsted, NY; University of Washington (J.J.T.), Seattle, WA; Geisinger Medical Center (C.T.), Danville, PA; and University of Pittsburgh (P.B.P.), PA. e-gerard@northwestern.edu.
² From the Northwestern University (E.E.G.), Chicago, IL; Stanford University (K.J.M.), Palo Alto, CA; The Emmes Company, LLC, (C.P.R., C.A.B., A.G.M.), Rockville, MD; Harvard University (P.E.V.), Boston, MA; University of Southern California (L.A.K.), Los Angeles, CA; Emory University (E.G.), Atlanta, GA; Minnesota Epilepsy Group (J.H.), Minneapolis, MN; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; New York University (J.A.F.); Columbia University (A.M.P.), New York, NY; Zucker School of Medicine at Hofstra Northwell (S.T.H.), Hempsted, NY; University of Washington (J.J.T.), Seattle, WA; Geisinger Medical Center (C.T.), Danville, PA; and University of Pittsburgh (P.B.P.), PA.

PMID: 37816636
PMCID: PMC10727216
DOI: 10.1212/WNL.0000000000207812

Abstract

Background and objectives: Breastfeeding has important health benefits for both mother and child. We characterize breastfeeding initiation and duration in mothers with epilepsy relative to control mothers in a large prospective cohort.

Methods: The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs study is a prospective, multicenter observational, US cohort study. Pregnant individuals with and without epilepsy, aged 14-45 years, were enrolled between December 19, 2012, and February 11, 2016. Exclusion criteria included intelligence quotient (IQ) <70, and gestational age >20 weeks at enrollment. Breastfeeding was assessed through electronic diary and at study visits until 2 years postpartum. Odds of initiating breastfeeding was compared between cohorts using unadjusted and adjusted logistic regression models. Duration of breastfeeding was compared between cohorts using the log-rank test.

Results: Three hundred fifty-one pregnant individuals with epilepsy and 105 pregnant controls were enrolled. Breastfeeding data were available for 325 mothers with epilepsy and 98 controls. Study cohorts were similar demographically except race (p = 0.008); 84.9% of mothers with epilepsy and 71.4% of controls were White. The mean IQ was lower in mothers with epilepsy compared with that in controls (97.7 vs 104.2, p < 0.001). Breastfeeding was initiated by 74.8% mothers with epilepsy and 88.8% controls; this difference was significant in unadjusted logistic regression (odds ratio [OR] 0.4 [95% CI 0.2, 0.7], p = 0.004), but not in adjusted model (OR 0.5 [95% CI 0.2, 1.0], p = 0.051). Factors associated with breastfeeding were higher maternal education and IQ. There was no difference in duration of breastfeeding between mothers with and without epilepsy (median duration 8.5 months vs 9.9 months, p = 0.793). Among mothers with epilepsy, both convulsive seizures and all seizures that impair awareness during pregnancy were associated with lower breastfeeding initiation (OR 0.4 [95% CI 0.2, 0.8], p = 0.013) and (OR 0.4 [95% CI 0.2, 0.8], p = 0.003, respectively). Any peripartum seizures were associated with shorter breastfeeding duration (median 6 months vs 9.7 months, [p = 0.040]).

Discussion: Mothers with epilepsy were less likely to initiate breastfeeding compared with controls; however, this difference was not significant when controlling for maternal IQ and education level. Continuation of breastfeeding once initiated was not different between mothers with and without epilepsy. Seizure control was associated with breastfeeding initiation and duration in mothers with epilepsy.

Trial registration information: ClinicalTrials.gov identifier NCT01730170.

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Conflict of interest statement

J. French receives salary support from the Epilepsy Foundation and for consulting work and/or attending Scientific Advisory Boards on behalf of the Epilepsy Study Consortium for Aeonian/Aeovian, Alterity Therapeutics Limited, Anavex, Arkin Holdings, Angelini Pharma S.p.A, Arvelle Therapeutics, Inc., Athenen Therapeutics/Carnot Pharma, Autifony Therapeutics Limited, Baergic Bio, Beacon Biosignals, Inc., Biogen, Biohaven Pharmaceuticals, BioMarin Pharmaceutical Inc., BioXcel Therapeutics, Bloom Science Inc., BridgeBio Pharma Inc., Camp4 Therapeutics Corporation, Cerebral Therapeutics, Cerevel, Clinical Education Alliance, Coda Biotherapeutics, Corlieve Therapeutics, Crossject, Eisai, Eliem Therapeutics, Encoded Therapeutics, Engage Therapeutics, Engrail, Epalex, Epihunter, Epiminder, Epitel Inc, Equilibre BioPharmaceuticals, Greenwich Biosciences, Grin Therapeutics, GW Pharma, Janssen Pharmaceutica, Jazz Pharmaceuticals, Knopp Biosciences, Korro Bio Inc., Lipocine, LivaNova, Longboard Pharmaceuticals, Lundbeck, Marinus, Mend Neuroscience, Merck, NeuCyte Inc., Neumirna Therapeutics, Neurocrine, Neuroelectrics USA Corporation, Neuronetics Inc., Neuropace, NxGen Medicine Inc., Ono Pharmaceutical Co., Otsuka Pharmaceutical Development, Ovid Therapeutics Inc., Paladin Labs Inc., Passage Bio, Pfizer, Praxis, PureTech LTY Inc., Rafa Laboratories Ltd, Receptor Holdings Inc., SK Life Sciences, Sofinnova, Stoke, Supernus, Synergia Medical, Takeda, Third Rock Ventures LLC, UCB Inc., Ventus Therapeutics, Xenon, Xeris, Zogenix, and Zynerba. J.A. French has also received research support from the Epilepsy Study Consortium (funded by Andrews Foundation, Eisai, Engage, Lundbeck, Pfizer, SK Life Science, Sunovion, UCB, Vogelstein Foundation) Epilepsy Study Consortium/Epilepsy Foundation (Funded by UCB), GW/FACES, and the NINDS. She is on the editorial board of Lancet Neurology and Neurology Today. She is Chief Medical/Innovation Officer for the Epilepsy Foundation. She has received travel reimbursement related to research, advisory meetings, or presentation of results at scientific meetings from the Epilepsy Study Consortium, the Epilepsy Foundation, Angelini Pharma S.p.A., Cerevel, Clinical Education Alliance, NeuCyte, Inc., Neurocrine, Praxis, and Xenon; E. Gerard is site PI for a clinical trial sponsored by Stanford University and Eisai. She has served as a site PI for trials sponsored by Sunovion, Xenon, and Sage. She has received speaking honoraria from GW Pharmaceuticals and Neurology Week; K.J. Meador has received research support from the NIH, Eisai, and Medtronic Inc. The Epilepsy Study Consortium pays his university for his research consultant time related to Eisai, GW Pharmaceuticals, NeuroPace, Novartis, Supernus, Upsher-Smith Laboratories, UCB Pharma, and Vivus Pharmaceuticals. In addition, K.J. Meador is Co-I and Director of Cognitive Core of the Human Epilepsy Project for the Epilepsy Study Consortium. K.J. Meador is on the editorial boards for Neurology, Cognitive & Behavioral Neurology, Epilepsy & Behavior, and Epilepsy & Behavior Case Reports; A.M. Pack has received royalties from UpToDate Inc. P.B. Pennell has received research support from the NIH and the Karger Foundation; honoraria for grant reviews from Harvard Medical School and the NIH; advisory board honorarium from Harvard School of Public Health; speaking honoraria and/or travel reimbursements from the American Epilepsy Society and American Academy of Neurology and various academic medical centers; and royalties from UpToDate Inc; J.J. Tsai has served as a site PI for trials sponsored by Xenon and SK Life Science; P. Emanuela Voinescu has received speaker honoraria from Harvard Medical School, StonyBrook University, Neurodiem and Physicians’ Education Resource; C.P. Robalino, C.A. Brown, A.G. Matthews, L.A. Kalayjian, E. Gedzelman, J.A. Hanna, J. Cavitt, M. Sam, S.T. Hwang, and C. Taylor report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

Figures

**Figure 1. Flow Diagram of Enrollment and Analysis Populations**
Of the pregnant persons assessed for eligibility, the most common reason for exclusion was pregnancy outside of the study parameters. The most common reason eligible patients were not enrolled was the time commitment to the study. Two pregnant subjects with epilepsy initially were discontinued from study because of a miscarriage and then reenrolled with a subsequent pregnancy.

**Figure 2. Kaplan-Meier Survival Curve and Log-Rank Test for Breastfeeding Duration in Mothers With Epilepsy and Controls (N = 330)**
Number at risk = number of mothers with evidence of breastfeeding at each 3-month interval.

**Figure 3. Kaplan-Meier Survival Curve and Log-Rank Test for Breastfeeding Duration in Mothers With Epilepsy**
Stratified by: (A) any peripartum seizures (N = 233) or (B) seizure type (N = 243). Number at risk = number of mothers with evidence of breastfeeding at each 3-month interval.

See this image and copyright information in PMC

References

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1. AAP. Breastfeeding Overview. aap.org/en/patient-care/breastfeeding/breastfeeding-overview/; 2021. Accessed April 22, 2022.
1. Turck D; Comité de nutrition de la Société française de pédiatrie. Breast feeding: health benefits for child and mother. Arch de Pédiatrie 2005;12(suppl 3):S145-S165. Doi. 10.1016/j.arcped.2005.10.006 - DOI - PubMed
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Initiation and Duration of Breastfeeding in the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs Study

Collaborators

Affiliations

Initiation and Duration of Breastfeeding in the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs Study

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Substances

Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Medical