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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
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.

T.M.-O. has received funding from NIMH (grant R01MH104468) and the Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark. S.A.K. has received funding from the Netherlands Organization for Scientific Research (the NWO Vidi incentive), the NeuroBasic-PharmaPhenomics consortium and the Dutch Technology Foundation (STW, OnTime Program 12197). V.B. is supported by the Netherlands Organization for Scientific Research (the NWO Innovational Research Incentives Scheme).

Declaration of interest

None.

Footnotes
References
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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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