Abstract
(1) To obtain objective information about levetiracetam transplacental passage and its transport into colostrum, mature milk, and breastfed infants, we analyzed data from women treated for epilepsy between October 2006 and January 2021; (2) in this cohort study, maternal, umbilical cord, milk, and infant serum concentrations were measured at delivery, 2–4 days postpartum (colostrum) and 7–31 days postpartum (mature milk). Paired umbilical cord serum, maternal serum, breastfed infant serum, and milk concentrations were used to assess the ratios of umbilical cord/maternal serum, milk/maternal serum, and infant/maternal serum concentrations. The influence of combined treatment with enzyme-inducing antiseizure medication carbamazepine was assessed; (3) the umbilical cord/maternal serum concentration ratio ranged between 0.75 and 1.78 (mean 1.10 ± 0.33), paired maternal and umbilical cord serum concentrations were not significantly different, and a highly significant correlation was found between both concentrations. The mean milk/maternal serum concentration ratio was 1.14 ± 0.27 (2–4 days postpartum) and 1.04 ± 0.24 (7–31 days postpartum) while the mean infant/maternal serum concentration ratio was markedly lower (0.19 ± 0.13 and 0.14 ± 0.05, respectively); (4) levetiracetam was found in the umbilical cord at a concentration similar to those in maternal serum. All of the breastfed infant serum concentrations were below the reference range used for the general epileptic population.
Highlights
Published: 17 March 2021The majority of women with epilepsy need to follow antiseizure medication (ASM)treatment during pregnancy and breastfeeding
Request forms for routine therapeutic drug monitoring (TDM) and maternal serum, umbilical cord serum, milk, and breastfed infant serum concentrations collected in our department between October 2006 and January were used as the data source
None of the infant serum concentrations was analyzed in the reference range used for the general epileptic population, one concentration was lower than the lower limit of quantification (LLoQ)
Summary
Published: 17 March 2021The majority of women with epilepsy need to follow antiseizure medication (ASM)treatment during pregnancy and breastfeeding. The majority of women with epilepsy need to follow antiseizure medication (ASM). A significant shift from “old” to “new”. Generation of ASM, especially lamotrigine (LTG) and levetiracetam (LEV), was described worldwide over the past decade [1,2]. Changes in LEV clearance during pregnancy were observed in some studies with a significant decline in plasma concentrations during pregnancy compared to the baseline levels before or after pregnancy [3,4,5,6]. The concentration of LEV increases rapidly after delivery, and baseline pre-pregnancy levels are reached within the first weeks after pregnancy. The effects of pregnancy on LEV disposition vary considerably between individuals and monitoring of LEV levels during pregnancy and after delivery is recommended [5,6]. An extensive transfer of LEV from mother to fetus and into breast milk was reported by some authors in small study groups or case-reports [4,5,6,7,8,9,10,11,12,13,14,15,16,17]
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