Veiby Gyri, Bjørk Marte, Engelsen Bernt A, Gilhus Nils Erik
Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Section for Neurology, University of Bergen, Norway.
Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Section for Neurology, University of Bergen, Norway.
Seizure. 2015 May;28:57-65. doi: 10.1016/j.seizure.2015.02.013. Epub 2015 Mar 16.
The objective of this paper is to provide a synopsis of benefits and potential harmful effects of exposure to antiepileptic drugs (AEDs) via breastmilk, and present recommendations for breastfeeding in women with epilepsy.
The article is based on a discretionary selection of English language articles retrieved by a literature search in the PubMed database, the LactMed database, and the authors' clinical experience.
Breastfeeding is associated with benefits for the infant, including nutrition, protection against infectious and immunological disease, and promotion of development and psychological attachment. Exposure to AEDs via breastmilk could potentially produce side effects or negatively affect development. Most studies on AED transfer through breastmilk report infant serum levels well below the limit of an expected pharmacological effect. Some drugs have the potential to reach significant serum levels in breastfed infants, such as barbiturates, benzodiazepines, lamotrigine, and ethosuximide. Thus, breastfed infants should be monitored for side effects. Still, adverse symptoms are rarely reported in breastfed infants of mothers taking AEDs, and prospective studies have failed to demonstrate any negative developmental effects in children that have been exposed to AEDs via breastmilk. The nursing infant's degree of drug exposure can be minimized by breastfeeding when drug concentrations in the milk are low, reducing maternal AED dosage to prepregnancy levels, and administering mixed nutrition.
Most AEDs are considered safe or moderately safe during breastfeeding. Mothers with epilepsy should be encouraged to breastfeed, provided careful monitoring of the infant.
本文旨在概述通过母乳接触抗癫痫药物（AEDs）的益处和潜在有害影响，并针对癫痫女性的母乳喂养提出建议。
本文基于在PubMed数据库、LactMed数据库中检索到的英文文章的自主选择，以及作者的临床经验。
母乳喂养对婴儿有益，包括营养、预防感染和免疫性疾病以及促进发育和心理依恋。通过母乳接触AEDs可能会产生副作用或对发育产生负面影响。大多数关于AEDs通过母乳转移的研究报告称，婴儿血清水平远低于预期药理作用的限度。有些药物有可能在母乳喂养的婴儿中达到显著的血清水平，如巴比妥类药物、苯二氮䓬类药物、拉莫三嗪和乙琥胺。因此，应对母乳喂养的婴儿进行副作用监测。不过，服用AEDs的母亲所喂养的婴儿很少报告有不良症状，前瞻性研究也未能证明通过母乳接触AEDs的儿童有任何负面发育影响。当乳汁中的药物浓度较低时进行母乳喂养、将母亲的AED剂量降至孕前水平以及给予混合营养，可以将哺乳婴儿的药物接触程度降至最低。
大多数AEDs在母乳喂养期间被认为是安全或中度安全的。应鼓励癫痫母亲进行母乳喂养，但需对婴儿进行仔细监测。
