Peripartum lithium management: Early maternal and neonatal outcomes

• Published in: Journal of affective disorders 2024-12, Vol.366, p.326-334
• Main Authors: Imaz, Maria Luisa, Torra, Mercè, Langohr, Klaus, Arca, Gemma, Soy, Dolors, Hernández, Ana Sandra, García-Esteve, Lluïsa, Vieta, Eduard, Martin-Santos, Rocio
• Format: Article
• Language: English
• Subjects: Bipolar disorder; lithium; Mother; Neonate; Peripartum; Placental passage
• ISSN: 0165-0327; 1573-2517; 1573-2517
• DOI: 10.1016/j.jad.2024.08.140

It has been suggested that a 30–50 % lithium dose reduction or lithium discontinuation 24-48 h before delivery could minimize neonatal complications. We investigated the maternal lithemia changes around delivery after a brief discontinuation, the placental transfer of lithium at delivery, and the association between neonatal lithemia at delivery and acute neonatal outcomes. A retrospective observational cohort study was conducted in a teaching hospital (November/2006-December/2018). Data was extracted from the medical records. We included psychopathologically stable women, with a singleton pregnancy, treated with lithium in late pregnancy, with at least one maternal and neonatal lithemia at delivery. Lithium was discontinued 12 h before a scheduled caesarean section or induction, or at admission day to hospital birth; and restarted 6-12 h post. Sixty-six mother-infant pairs were included, and 226 maternal and 66 neonatal lithemias were obtained. We found slight maternal lithemia fluctuations close to 0.20 mEq/L, and early postpartum relapse of 6 %. The mean (SD) umbilical cord/mother intrapartum lithemia ratio was 1.10 (0.17). Fifty-six percent of neonates presented transient acute complications. Neonatal hypotonia was the most frequent outcome (N = 15). Mean lithemia were 0.178 mEq/L higher in those with hypotonia than in those without (p = 0.028). It is a retrospective cohort of a moderate sample size of healthy uncomplicated pregnancies and results cannot be generalized to all pregnant treated with lithium. Lithium transfers completely across the placenta. A brief predelivery lithium discontinuation was associated with slight maternal lithemia fluctuations. Neonates exposed intrautero to lithium present frequent but transient acute effects. •Lithium completely equilibrates across the placenta, both in mono and polytherapy•A brief peripartum discontinuation is associated with slight lithemia fluctuations.•Neonatal lithemia at delivery is associated with transient neonatal complications.