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.

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.

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]).

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.

ClinicalTrials.gov identifier NCT01730170.

母乳喂养对母亲和孩子都有重要的健康益处。我们在一个大型前瞻性队列中描述了癫痫母亲相对于对照母亲的母乳喂养开始和持续时间的特征。

抗癫痫药物的孕产妇结局和神经发育影响研究是一项前瞻性、多中心观察性美国队列研究。2012年12月19日至2016年2月11日期间纳入患有或不患有癫痫的孕妇，年龄为14-45岁。排除标准包括入组时智商（IQ）<70，胎龄>20周。母乳喂养通过电子日记和研究访问进行评估，直至产后 2 年。使用未调整和调整的逻辑回归模型比较队列之间开始母乳喂养的几率。使用对数秩检验比较队列之间的母乳喂养持续时间。

招募了 351 名患有癫痫症的孕妇和 105 名怀孕对照者。可获得 325 名癫痫母亲和 98 名对照母亲的母乳喂养数据。除种族外，研究队列在人口统计学上相似（p = 0.008）；84.9% 患有癫痫的母亲和 71.4% 的对照者是白人。与对照组相比，患有癫痫的母亲的平均智商较低（97.7 vs 104.2，p < 0.001）。74.8% 的癫痫母亲和 88.8% 的对照母亲开始母乳喂养；这种差异在未调整的逻辑回归中显着（比值比 [OR] 0.4 [95% CI 0.2, 0.7]，p = 0.004），但在调整后的模型中不显着（OR 0.5 [95% CI 0.2, 1.0]，p = 0.051） 。与母乳喂养相关的因素是较高的母亲教育程度和智商。患有和不患有癫痫的母亲之间的母乳喂养持续时间没有差异（中位持续时间 8.5 个月 vs 9.9 个月，p = 0.793）。在患有癫痫的母亲中，惊厥性癫痫发作和怀孕期间所有损害意识的癫痫发作均与较低的母乳喂养起始时间相关（OR 0.4 [95% CI 0.2, 0.8]，p = 0.013）和（OR 0.4 [95% CI 0.2, 0.8] ，p = 0.003，分别）。任何围产期癫痫发作都与较短的母乳喂养时间相关（中位 6 个月 vs 9.7 个月，[ p = 0.040]）。

与对照组相比，患有癫痫症的母亲开始母乳喂养的可能性较小；然而，当控制母亲的智商和教育水平时，这种差异并不显着。一旦开始母乳喂养，患有和不患有癫痫的母亲之间的持续母乳喂养没有差异。癫痫母亲的癫痫发作控制与母乳喂养的开始和持续时间相关。

ClinicalTrials.gov 标识符 NCT01730170。