Valproic Acid Concentrations in Mothers, Colostrum and Breastfed Infants during the Early Postpartum Period: Comparison with Concentrations Determined during Delivery and in the Mature Milk Period

To obtain information on the transport of valproic acid from mothers to colostrum and breastfed infants, in this cohort study, valproic acid concentrations in maternal serum (90 subjects), colostrum and the serum of breastfed infants were analyzed in years 1993-2018, between the 2nd and 5th postnatal days. Valproic acid concentrations ranged from 4.3 to 66.5 mg/L (mean 31.2 +/- 13.6 mg/L) in maternal serum, from 0.5 to 5.9 mg/L (mean 1.1 +/- 1.2 mg/L) in milk, and from 0.5 to 42.9 mg/L (mean 15.4 +/- 9.4 mg/L) in infant serum. The milk/maternal serum concentration ratio ranged from 0.01 to 0.22 (mean 0.04 +/- 0.04), and the infant/maternal serum concentration ratio ranged from 0.01 to 1.61 (mean 0.51 +/- 0.28). A significant correlation was found between serum concentrations of breastfed infants and milk concentrations, maternal serum concentrations, maternal daily dose, and dose related to maternal body weight. Valproic acid concentrations in milk and infant serum did not reach the lower limit of the reference range used for the general epileptic population, and three-quarters of the concentrations in milk were lower than the lower limit of quantification. Routine monitoring of serum concentrations of breastfed infants is not necessary. If signs of potential adverse reactions are noted, serum concentrations of the infants should be measured.

Automated summary

The study found significant correlations between milk/maternal serum concentration ratio and infant/maternal serum concentration ratio. Valproic acid concentrations in milk and infant serum did not reach the lower limit of the reference range for the general epileptic population, indicating that routine monitoring of serum concentrations of breastfed infants is not necessary.