抗癫痫药物对母婴结局和神经发育影响的研究中的母乳喂养起始和持续时间。
Initiation and Duration of Breastfeeding in the Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs Study.
机构信息
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.
出版信息
Neurology. 2023 Nov 27;101(22):e2266-e2276. doi: 10.1212/WNL.0000000000207812.
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 ( = 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, < 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], = 0.004), but not in adjusted model (OR 0.5 [95% CI 0.2, 1.0], = 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, = 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], = 0.013) and (OR 0.4 [95% CI 0.2, 0.8], = 0.003, respectively). Any peripartum seizures were associated with shorter breastfeeding duration (median 6 months vs 9.7 months, [ = 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.
背景和目的
母乳喂养对母婴双方都有重要的健康益处。我们在一项大型前瞻性队列研究中，对患有癫痫的母亲与对照母亲的母乳喂养起始和持续时间进行了描述。
方法
《抗癫痫药物对母婴结局和神经发育影响的研究》是一项前瞻性、多中心、美国队列研究。招募年龄在 14 至 45 岁之间的患有癫痫和不患有癫痫的孕妇，招募时间为 2012 年 12 月 19 日至 2016 年 2 月 11 日。排除标准包括智商（IQ）<70 岁，以及入组时妊娠周数>20 周。通过电子日记和研究访问评估母乳喂养情况，直到产后 2 年。使用未调整和调整后的逻辑回归模型比较队列间母乳喂养的起始概率。使用对数秩检验比较队列间母乳喂养的持续时间。
结果
共有 351 名患有癫痫的孕妇和 105 名患有对照的孕妇入组。325 名患有癫痫的母亲和 98 名对照的母亲提供了母乳喂养数据。研究队列在人口统计学方面相似，除了种族（ = 0.008）；84.9%的患有癫痫的母亲和 71.4%的对照是白人。与对照组相比，患有癫痫的母亲的平均 IQ 较低（97.7 与 104.2，<0.001）。74.8%的患有癫痫的母亲和 88.8%的对照开始母乳喂养；这在未调整的逻辑回归中差异显著（优势比[OR]0.4[95%CI0.2,0.7]， = 0.004），但在调整后的模型中无差异（OR0.5[95%CI0.2,1.0]， = 0.051）。与母乳喂养相关的因素是较高的母亲教育程度和 IQ。患有癫痫的母亲和不患有癫痫的母亲的母乳喂养持续时间无差异（中位数持续时间为 8.5 个月与 9.9 个月， = 0.793）。患有癫痫的母亲中，妊娠期有癫痫发作和所有影响意识的癫痫发作均与母乳喂养起始率较低相关（OR0.4[95%CI0.2,0.8]， = 0.013）和（OR0.4[95%CI0.2,0.8]， = 0.003，分别）。任何围产期癫痫发作均与母乳喂养持续时间较短相关（中位数 6 个月与 9.7 个月， = 0.040）。
讨论
与对照组相比，患有癫痫的母亲开始母乳喂养的可能性较低；然而，当控制母亲的 IQ 和教育水平时，这种差异并不显著。一旦开始母乳喂养，患有癫痫的母亲和不患有癫痫的母亲的母乳喂养持续时间没有差异。癫痫控制与患有癫痫的母亲的母乳喂养起始和持续时间相关。
试验注册信息
ClinicalTrials.gov 标识符 NCT01730170。
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