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Lithium placental passage at delivery and neonatal outcomes: A retrospective observational study

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, Department Of Psychiatry And Psychology, Idibaps, Hospital Clinic Barcelona, Barcelona, Spain
R. Martin-Santos
Affiliation:
Psychiatry And Psychology Department, Cibersam, Idibaps, Ub, Hospital Clinic, Barcelona, Spain
*
*Corresponding author.

Abstract

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Introduction

Lithium is an effective mood stabilizer and is widely used as a first-line treatment for bipolar disorder in the perinatal period. Several guidelines have provided clinical advice on dosing strategy (dose reduction versus stop lithium) in the peripartum period to minimize the risk of neonatal complications. An association has been observed between high neonatal lithium concentrations (> 0.64 mEq/L) and lower 1-min Apgar scores, longer hospital stays, and central nervous system and neuromuscular complications.

Objectives

To quantify the rate of lithium placental passage at delivery. To assess any association between plasma concentration of lithium at delivery and neonatal outcome.

Methods

In this retrospective observational cohort study, we included women treated with llithium at least in late pregnancy. Maternal (MB) and umbilical cord (UC) lithium blood level measurement were collected at delivery. Lithium serum concentrations were determined by means of an AVL 9180 electrolyte analyzer. The limit of quantification (LoQ) was 0.20 mEq/L and detection limit was 0.10 mEq/L. From the medical records, we extracted information on neonatal outcomes (preterm birth, birth weight, Apgar scores, pH-values, and admision to NICU) and complications categoriced by organ system: respiratory, circulatory, hematological, gastro-intestinal, metabolic, neurological, and immune system (infections).

Results

Umbilical cord and maternal lithium blood levels were strongly correlated: mean (SD) range UC/MR ratio 1.15 (0.24). Umbilical cord lithium levels ranged between 0.20 to 1.42 mEq/L. We observed no associations between umbilical cord lithium blood levels at delivery and neonatal outcomes.

Conclusions

In our study, newborns tolerated well a wide range of lithemias, between 0.20 and 1.42 mEq/L.

Keywords

NeonatelithiumPlacental transferDelivery
Type
Abstract
Information
European Psychiatry , Volume 64 , Special Issue S1: Abstracts of the 29th European Congress of Psychiatry , April 2021 , pp. S203
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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