Wednesday, November 28, 2007

Can you Breastfeed on Lamictal?

Deciding to take Lamictal during my second and third trimester was a big decision, but at least when making the decision I could turn to the pregnancy registries to see what data existed -- and those numbers are based on hundreds of women who have taken Lamictal during their pregnancies.

Deciding to breastfeed while on Lamictal is almost as difficult of a decision except there is NO "registry" to turn to for answers. My psychiatrist requested the information about Lamicatal during lacation and the data is pretty skimpy.

Here's what they know:
1. Lamictal does pass into breast milk.
2. The effects of infants exposed to Lamictal through breastmilk is unknown.
3. The concentration in a breast-fed infant is somewhere between 16-60% of the concentration found in the mother's blood.
4. No siginficant adverse effects were reported in infants exposed to Lamictal through breastmilk.

Out of the 5 studies that have been done there have only been 41 women followed. That is not a typo the scientific data that exists is about only 41 women.

So the question is do the benefits of breastfeeding which are numerous -- outweigh the risks (which are basically unknown)?

Some doctors believe that because a baby has already been exposed while in the womb there is really no additional risk since the baby will get less Lamictal through breastmilk than she was getting while inside.

I discussed this with my OB/GYN who advice basically was do what you feel is right, my babies future pediatrician who pulled out a book and said "says here it isn't recommended" and my psychiatrist who has reviewed the current studies with me. My psychiatrist beleives that the benefits DO outweigh the risks especially since their isn't any data that shows it is bad for the baby -- just data that says it passes into breastmilk. Since my baby has been exposed to Lamictal in utero for the last 6 month I can't imagine that a little pass through in the milk is going to be anymore harmful than being exposed directly.

Here are some helpful links I found:
- Lamtical & breastfeeding message board post at Epilepsy.com
- Lamictal and breastfeeding question (towards the bottom of the page)
- Center for Women's Mental Health Blog Post on Lamictal & Breastfeeding

UPDATE: August 2011
I wanted to post a long overdue follow-up to this post. I did end up breastfeeding for 1 year while taking Lamictal. My daughter had no side effects from an exposure in breastmilk.

She is now a very healthy 3 1/2 year old who just started preschool. She has always been ahead of every developmental milestone from walking to talking to writing her name.

When we eventually have a second child, I do plan on taking Lamictal during the pregnancy and during breastfeeding.
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