“To feed or not to feed?”: assessing long-term effects of breastfeeding on mental development of children from mothers with epilepsy

Background. Traditionally, the influence of maternal intake of antiepileptic drugs during breastfeeding has been studied in terms of their concentration in breast milk and infant serum, whereas their long-term consequences for child development have not been assessed. In this regard, no comparison has been made of the further mental development and adaptation of children who were breastfed and formula-fed, which is why the issue of breastfeeding safety while receiving antiepileptic therapy remains controversial to this day. Nor the development of children born to mothers with epilepsy, delivered naturally and by cesarean section, has been compared as well. Meanwhile, these two issues (the choice of delivery method and type of feeding) are of vital importance for such women.

Objective: To study an influence of intranatal and neonatal factors on the mental development of children born to mothers with epilepsy.

Material and methods. A study investigating the impact of intranatal (delivery routes) and neonatal (feeding type) factors on the mental development of children born to mothers with epilepsy was conducted by enrolling 176 participants: 88 children aged 3–9 years and paired mothers suffering from epilepsy. The following methods were used: forms for parents – Child Behavior Checklist (CBCL) by T. Achenbach, attention deficit hyperactivity disorder and other behavioral dysfunction questionnaire modified by N.N. Zavadenko, as well as Luria neuropsychological batteries by J.M. Glozman, and Wechsler Intelligence Scale for Children (WSIC). A detailed history of the mother’s illness and early child development was also collected. Statistical data processing was performed in the IBM SPSS using Pearson's χ2 coefficient, nonparametric U Mann–Whitney criterion, multivariate analysis of variance, correlation, regression analysis, and moderator analysis.

Results. Children born by cesarean section subsequently exhibited more pronounced motor awkwardness, speech development delays, difficulties with voluntary attention concentration, and handling numerical material. Children who were breastfed subsequently had less severe emotional and volitional disorders, as well as better developed subject gnosis, reciprocal coordination, spontaneous speech, understanding of addressed speech and speech logic, as well as non-verbal intelligence. Regression analysis showed that artificial feeding in combination with prenatal risk factors (maternal epileptic seizures before and during pregnancy, anemia, valproic acid intake) has important prognostic significance in developing emotional and volitional disorders, delays in the development of praxis, gnosis, spontaneous speech, understanding of addressed speech, as well as functional underdevelopment of the left temporal lobe in children.

Conclusion. Breastfeeding can be considered as a moderator that reduces the negative impact of anemia on further neurocognitive development of children born to mothers with epilepsy.

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