A 22-Year-Old Primigravida Comes to the Office at 12 Weeks

A 22-year-old primigravida comes to the office at 12 weeks gestation for her first prenatal visit.  The patient was unaware that she was pregnant until last week, when she went to the emergency department for persistent vomiting; an ultrasound confirmed an intrauterine pregnancy.  The patient has irregular menstrual cycles due to polycystic ovary syndrome.  Nine months ago, she stopped taking oral contraceptives due to intolerable side effects; she did not inform her provider.  The patient also has a history of idiopathic seizures beginning in childhood and receives valproate monotherapy.  She states, "I just read in one of those maternity books that seizure medications can be bad for my baby.  Should I stop now?  I have not had a seizure in a long time."  Her last seizure occurred a year ago after an attempt to change her medication regimen; she was hospitalized for aspiration pneumonia afterward.  The patient does not use tobacco, alcohol, or illicit drugs.  There is no family history of congenital abnormalities. This patient's pregnancy was uneventful and she delivered a healthy baby.  She has heard about the benefits of breastfeeding and asks if she can breastfeed while taking her medication.  Which of the following is the most appropriate response to this patient?

A) Antiepileptic medications are not harmful as they do not pass into breast milk.
B) Breastfeeding is not generally contraindicated while taking antiepileptics.
C) Breastfeeding while taking antiepileptics is associated with adverse long-term effects.
D) Breastfeeding while taking antiepileptics is associated with unacceptable risks to infants.
E) Breastfeeding while taking antiepileptics may decrease the child's susceptibility to epilepsy.