Dear Terry,

Here is what 2019 Dr. Hale has to share:

* listed as L2, significant data - compatible
* "The use of lamotrigine in breastfeeding mothers produces significant plasma levels in some breastfeeding infants, although they are apparently not high enough to produce side effects in most cases. Exposure in utero is considerably higher and levels with probably drop postnatally in newborn infants who are breastfed. Nevertheless, it is advisable to monitor the infant's plasma levels  closely to ensure safety. In two recent studies by Meador et al, no untoward effects on IQ levels were noted in children age 3 years when exposed to lamotrigine during pregnancy and breastfeeding."
* He cites a Norwegian study that suggests that for babies who have been exposed in utero, breastfeeding in the first 6 months demonstrated an trend toward improvement in all developmental domains and continuous breastfeeding (daily for more than 6 months) reduced the impairment in development at 6 and 28 months compared to those with no breastfeeding or breastfeeding less than 6 months. The authors concluded that women with epilepsy should be encourage dot breastfeed regardless of the anti epileptic medication.
* Under "pediatric concerns" he states that there has been one case reported of severe neonatal apnea in an infant.  Mild throbocytosis has also been reported in one study of seven of eight infants. Breast milk levels are relatively high; reported infant plasma levels are 15-30% of maternal levels.
* Under "infant monitering" he lists: sedation or irritability, not waking to feed/poor feeding, weight gain and rash.  Based oil clinical symptoms some infants may require monitoring of liver enzymes or CBC.
* He does not indicate any alternatives.

I hope this is helpful. You can also contact the InfantRiskCenter directly.

Cindy Garrison BS IBCLC

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