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Infant exposure to lithium through breast milk

Published online by Cambridge University Press:  13 August 2021

M.L. Imaz ,
M. Torra ,
D. Soy ,
K. Langorh ,
L. Garcia-Esteve  and
R. Martin-Santos
M.L. Imaz*
Affiliation:
Unit Of Perinatal Mental Health Clinic-bcn, Department Of Psychiatry And Psychology, Institut Of Neuroscience, Institut D’investigacions Biomèdiques August Pi I Sunyer (idibaps), And Department Of Medicine, University Of Barcelona (ub), Hospital Clinic Barcelona, Barcelona, Spain
M. Torra
Affiliation:
Pharmacology And Toxicology Laboratory, Biochemistry And Molecular Genetics Service, Biomedical Diagnostic Center, Idibaps, Hospital Clinic Barcelona, Barcelona, Spain
D. Soy
Affiliation:
Division Of Medicines, Pharmacy Service, Idibaps, Hospital Clinic Barcelona, Barcelona, Spain
K. Langorh
Affiliation:
Grass Research Group In Survival Analysis. Department Of Statistic And Operations Research., Universitat Politècnica de Catalunya, Barcelona, Spain
L. Garcia-Esteve
Affiliation:
Unit Of Perinatal Mental Health Clinic-bcn, Department Of Psychiatry And Psychology, Institut Of Neuroscience, Idibaps, Hospital Clinic Barcelona, Barcelona, Spain
R. Martin-Santos
Affiliation:
Psychiatry And Psychology Department, Centro De Investigación Biomédica En Red En Salud Mental (cibersam), Institut D’investigacions Biomèdiques August Pi I Sunyer (idibaps), Universitat Barcelona (ub), Hospital Clinic Barcelona, Barcelona, Spain
*
*Corresponding author.

Abstract

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Introduction

Women who take lithium during pregnancy and continue after delivery may opt to breastfeed, formula feed, or mix these options.

Objectives

To evaluate the neonatal lithium plasma concentrations and nursing infant outcomes based on these three feeding trajectories.

Methods

We followed 24 women with bipolar disorder on lithium monotherapy during late pregnancy and postpartum (8 per trajectory). Lithium serum concentrations were determined by an AVL 9180 electrolyte analyser with a 0.10 mEq/L detection limit and a 0.20 mEq/L limit of quantification (LoQ).

Results

The mean ratio of lithium concentration in the umbilical cord to maternal serum being 1.12 (0.17). We used the Turnbull estimator for interval-censored data to estimate the probability that the LoQ was reached as a function of time. The median times to LoQ was 6–8, 7–8, and 53–60 days for formula, mixed, and breastfeeding, respectively. Generalised log-rank testing indicated that the median times to LoQ differed by feeding trajectory (p = 0.037). Multivariate analysis confirmed that the differences remained after adjusting for serum lithium concentrations at birth (formula, p = 0.015; mixed, p = 0.012). We did not found any acute observable growth or developmental delays in any of the neonates/infants.

Conclusions

Lithium did not accumulate in the infant under either exclusive or mixed-breastfeeding. Lithium concentrations declined in all trayectories. The time needed to reach the LoQ was much longer for those breastfeeding exclusively. Lithium transfer via breastmilk is much less than via the placenta. We did not found any acute observable growth or developmental delays in any infant during follow-up.

Disclosure

No significant relationships.

Keywords

lithiumMaternal breastfeedingFormula feedingPlacental transfer
Type
Abstract
Information
European Psychiatry , Volume 64 , Special Issue S1: Abstracts of the 29th European Congress of Psychiatry , April 2021 , pp. S180
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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