Abstracts

Factors Affecting Breastfeeding Patterns in Women with Epilepsy

Abstract number : 1.246
Submission category : 4. Clinical Epilepsy / 4E. Women's Issues
Year : 2019
Submission ID : 2421241
Source : www.aesnet.org
Presentation date : 12/7/2019 6:00:00 PM
Published date : Nov 25, 2019, 12:14 PM

Authors :
Abrar O. Al-faraj, Beth Israel deaconess Medical center/Harvard medical school.; Rebekah Wigton, Beth Israel Deaconess Medical Center; Trudy D. Pang, Beth Israel Deaconess Medical Center/Harvard Medical School

Rationale: The benefits of breastfeeding are well-established in the general population, and recent studies confirmed safety and possible additional benefits in neurodevelopment children born to women with epilepsy (WWE) (Lancet Neurol 2013; 3:244-252). However, studies suggest that breast-feeding rates in WWE are significantly lower than that of the general population (JAMA Neurol. 2013; 70(11):1367-1374; Lancet Neurol 2013; 3:244-252). In this study, we aimed to: 1) Compare the rate of initiation and adherence of breastfeeding in WWE with healthy controls. 2) Identify potential factors that affect breastfeeding in WWE. 3) Assess the influence of support systems on breastfeeding, such as lactation consult services. By understanding these various factors, we hope to propose next steps in potential intervention strategies to maximize the benefits of breastfeeding in WWE. Methods: We retrospectively studied WWE in the Beth Israel Deaconess Medical center (BIDMC) Epilepsy Clinic who underwent pregnancies (N=102) and compared them to healthy controls without epilepsy (N=113) from the obstetrical service at BIDMC (between 2009 and 2018). Medical records were reviewed for the following: demographic characteristics, epilepsy type, degree of seizure control during pregnancy and postpartum, number of antiepileptic medications (AEDs), breastfeeding education by providers (neurologists and epilepsy nursing), lactation consult, and rate of initiation and adherence to breastfeeding at the following time points: 6 weeks, 3 months, and 6 months. Patients with other chronic medical conditions or taking medications other than AED that may impact breastfeeding or with limited follow up during pregnancy and postpartum periods were excluded from the analysis.  Results: In the 102 WWE and 113 healthy controls with age range between 20-40 years old who met the inclusion criteria, breastfeeding initiation rate was significantly lower in WWE at 51% compared to 87% in the control group; this rate declined significantly to 38.2% at 6 weeks compared to 76% in the control group. Adherence was even lower in WWE at 36.2% at 3 months and 18.6% at 6 months. In WWE, reasons for not breastfeeding were known in 17.6% of the patients and included fear of AED exposure through breast milk, recommendations by different providers (pediatricians, obstetricians) not to breastfeed, failed breastfeeding trials due to technical difficulties, and lack of milk supply. Discussion about breastfeeding by the treating neurologist occurred in 52.9% of WWE and 91% by the epilepsy nurse. Among the 66% of patients who received their obstetrical care at BIDMC, only 13% of WWE received lactation consultation postpartum compared to 58% in the healthy control group.  We found a statistically significant positive correlation between breastfeeding education by the treating neurologist and decision to breastfeed χ2=9.16, 1 df, p<0.005
Clinical Epilepsy