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  • Cited by 5
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    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.
    Clark, Crystal T. and Wisner, Katherine L. 2018. Treatment of Peripartum Bipolar Disorder. Obstetrics and Gynecology Clinics of North America, Vol. 45, Issue. 3, p. 403.
    Luu, Brent and Rodway, George 2018. Lithium Therapy for Bipolar Disorder. The Journal for Nurse Practitioners, Vol. 14, Issue. 2, p. 93.
    Patel, Maxine X Sethi, Faisil N Barnes, Thomas RE Dix, Roland Dratcu, Luiz Fox, Bernard Garriga, Marina Haste, Julie C Kahl, Kai G Lingford-Hughes, Anne McAllister-Williams, Hamish O’Brien, Aileen Parker, Caroline Paterson, Brodie Paton, Carol Posporelis, Sotiris Taylor, David M Vieta, Eduard Völlm, Birgit Wilson-Jones, Charlotte and Woods, Laura 2018. Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation. Journal of Psychopharmacology, Vol. 32, Issue. 6, p. 601.
    Poels, Eline M. P. Bijma, Hilmar H. Galbally, Megan and Bergink, Veerle 2018. Lithium during pregnancy and after delivery: a review. International Journal of Bipolar Disorders, Vol. 6, Issue. 1,
    Wesseloo, Richard Liu, Xiaoqin Clark, Crystal T. Kushner, Steven A. Munk-Olsen, Trine and Bergink, Veerle 2017. Risk of postpartum episodes in women with bipolar disorder after lamotrigine or lithium use during pregnancy: A population-based cohort study. Journal of Affective Disorders, Vol. 218, Issue. , p. 394.
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Lithium dosing strategies during pregnancy and the postpartum period

  • Richard Wesseloo (a1), André I. Wierdsma (a1), Inge L. van Kamp (a2), Trine Munk-Olsen (a3), Witte J. G. Hoogendijk (a4), Steven A. Kushner (a4) and Veerle Bergink (a4)...
Abstract
Background

Lithium is challenging to dose during pregnancy.

Aims

To provide guidance for dosing lithium during pregnancy.

Method

Retrospective observational cohort study. Data on lithium blood level measurements (n = 1101), the daily lithium dose, dosing alterations/frequency and creatinine blood levels were obtained from 113 pregnancies of women receiving lithium treatment during pregnancy and the postpartum period.

Results

Lithium blood levels decreased in the first trimester (−24%, 95% CI −15 to −35), reached a nadir in the second trimester (−36%, 95% CI −27 to −47), increased in the third trimester (−21%, 95% CI −13 to −30) and were still slightly increased postpartum (+9%, 95% CI +2 to +15). Delivery itself was not associated with an acute change in lithium and creatinine blood levels.

Conclusions

We recommend close monitoring of lithium blood levels until 34 weeks of pregnancy, then weekly until delivery and twice weekly for the first 2 weeks postpartum. We suggest creatinine blood levels are measured to monitor renal clearance.

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Copyright
COPYRIGHT: © The Royal College of Psychiatrists 2017 
Corresponding author
Richard Wesseloo, MD, Department of Psychiatry, Erasmus Medical Centre, 's Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands. Email: r.wesseloo@erasmusmc.nl
Footnotes
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†

See editorial, pp. 3–4, this issue.

Declaration of interest

None.

Footnotes
References
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  • Cited by 5
  • Cited by
    Crossref Citations
    Crossref logo
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.
    Clark, Crystal T. and Wisner, Katherine L. 2018. Treatment of Peripartum Bipolar Disorder. Obstetrics and Gynecology Clinics of North America, Vol. 45, Issue. 3, p. 403.
    Luu, Brent and Rodway, George 2018. Lithium Therapy for Bipolar Disorder. The Journal for Nurse Practitioners, Vol. 14, Issue. 2, p. 93.
    Patel, Maxine X Sethi, Faisil N Barnes, Thomas RE Dix, Roland Dratcu, Luiz Fox, Bernard Garriga, Marina Haste, Julie C Kahl, Kai G Lingford-Hughes, Anne McAllister-Williams, Hamish O’Brien, Aileen Parker, Caroline Paterson, Brodie Paton, Carol Posporelis, Sotiris Taylor, David M Vieta, Eduard Völlm, Birgit Wilson-Jones, Charlotte and Woods, Laura 2018. Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation. Journal of Psychopharmacology, Vol. 32, Issue. 6, p. 601.
    Poels, Eline M. P. Bijma, Hilmar H. Galbally, Megan and Bergink, Veerle 2018. Lithium during pregnancy and after delivery: a review. International Journal of Bipolar Disorders, Vol. 6, Issue. 1,
    Wesseloo, Richard Liu, Xiaoqin Clark, Crystal T. Kushner, Steven A. Munk-Olsen, Trine and Bergink, Veerle 2017. Risk of postpartum episodes in women with bipolar disorder after lamotrigine or lithium use during pregnancy: A population-based cohort study. Journal of Affective Disorders, Vol. 218, Issue. , p. 394.
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Lithium dosing strategies during pregnancy and the postpartum period

  • Richard Wesseloo (a1), André I. Wierdsma (a1), Inge L. van Kamp (a2), Trine Munk-Olsen (a3), Witte J. G. Hoogendijk (a4), Steven A. Kushner (a4) and Veerle Bergink (a4)...
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