1354 “Narcolepsy Prepared Me for Motherhood”: Continuous Sodium Oxybate Use in Pregnancy and Lactation with Safe Maternal and Infant Outcomes

Abstract Introduction Evidence to guide the management of narcolepsy during pregnancy and lactation is extremely limited, particularly regarding the safety of sodium oxybate, and existing literature is sparse, suggesting no clear teratogenicity, but highlights theoretical neonatal sedation and recommends timed breastfeeding. Women with narcolepsy frequently face overlapping physiologic, occupational, and psychosocial pressures during pregnancy and the postpartum period, yet few contemporary case reports describe real-world maternal and neonatal outcomes. This case presents a rare, detailed longitudinal description of continuous sodium oxybate exposure throughout pregnancy, temporary postpartum discontinuation, and structured reintroduction during breastfeeding, with healthy maternal and infant outcomes. Report of case(s) This is a 31-year-old woman with narcolepsy type 1, controlled on sodium oxybate 6 g nightly, who continued therapy throughout pregnancy following multidisciplinary counseling and shared decision-making. Her care team included maternal–fetal medicine, sleep medicine, anesthesiology, psychiatry, lactation consultants, and neonatal specialists, alongside strong family support. She also worked in a high-pressure executive role requiring sustained vigilance, rapid processing, and complex reasoning, making stable alertness essential for occupational functioning. Pregnancy, delivery, and neonatal course were uncomplicated, and the infant exhibited no sedation, withdrawal, or respiratory concerns. Sodium oxybate was withheld approximately 48–60 hours before delivery. Postpartum, she remained off medication for 12 weeks to exclusively breastfeed, describing the experience as: “Narcolepsy prepared me for motherhood; being sleep deprived without medication is the exact same as having a newborn.” She later resumed sodium oxybate while breastfeeding using a structured pump-and-feed schedule. The infant demonstrated normal growth and development through three years of follow-up. After consent, data were collected through chart review and a structured follow-up interview. Conclusion With individualized assessment, coordinated multidisciplinary management, and precise feeding/dosing planning, sodium oxybate may be safely continued during pregnancy and reintroduced during lactation for select patients with narcolepsy, demonstrating feasibility when aligned with the medication’s short half-life and supported by expert monitoring. This case is a rare, detailed real-world evidence supporting shared decision-making and underscores the urgent need for systematic research on sodium oxybate use during pregnancy, delivery, and breastfeeding. Support (if any) None