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Peripartum lithium management: Early maternal and neonatal outcomes

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Background: It has been suggested that a 30-50% lithium dose reduction or lithium  discontinuation 24-48h 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.  Methods: 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 12h before a scheduled caesarea section or induction, or at admission day to hospital birth; and restarted 6-12h post.  Results: 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).  Limitations: 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.  Conclusions: 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.

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Journal of Affective Disorders, 2024, vol. 366, p. 326-334

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Articles publicats en revistes (Farmacologia, Toxicologia i Química Terapèutica)

# metadata.dc.title[].value
Peripartum lithium management: Early maternal and neonatal outcomes