Lithium placental passage at delivery and neonatal outcomes: A retrospective observational study
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...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2021-04-01
|
| Series: | European Psychiatry |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S092493382100540X/type/journal_article |
| _version_ | 1797617159992508416 |
|---|---|
| author | M.L. Imaz M. Torra D. Soy K. Langorh L. Garcia-Esteve R. Martin-Santos |
| author_facet | M.L. Imaz M. Torra D. Soy K. Langorh L. Garcia-Esteve R. Martin-Santos |
| author_sort | M.L. Imaz |
| collection | DOAJ |
| description |
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.
|
| first_indexed | 2024-03-11T07:50:54Z |
| format | Article |
| id | doaj.art-ce714f65ffb14f47ab5915b12f999c5b |
| institution | Directory Open Access Journal |
| issn | 0924-9338 1778-3585 |
| language | English |
| last_indexed | 2024-03-11T07:50:54Z |
| publishDate | 2021-04-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | European Psychiatry |
| spelling | doaj.art-ce714f65ffb14f47ab5915b12f999c5b2023-11-17T05:06:45ZengCambridge University PressEuropean Psychiatry0924-93381778-35852021-04-0164S203S20310.1192/j.eurpsy.2021.540Lithium placental passage at delivery and neonatal outcomes: A retrospective observational studyM.L. Imaz0M. Torra1D. Soy2K. Langorh3L. Garcia-Esteve4R. Martin-Santos5Unit 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, SpainPharmacology And Toxicology Laboratory, Biochemistry And Molecular Genetics Service, Biomedical Diagnostic Center, Idibaps, Hospital Clinic Barcelona, Barcelona, SpainDivision Of Medicines, Pharmacy Service, Idibaps, Hospital Clinic Barcelona, Barcelona, SpainGrass Research Group In Survival Analysis. Department Of Statistic And Operations Research., Universitat Politècnica de Catalunya, Barcelona, SpainUnit Of Perinatal Mental Health, Department Of Psychiatry And Psychology, Idibaps, Hospital Clinic Barcelona, Barcelona, SpainPsychiatry And Psychology Department, Cibersam, Idibaps, Ub, Hospital Clinic, Barcelona, Spain 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. https://www.cambridge.org/core/product/identifier/S092493382100540X/type/journal_articleNeonatelithiumPlacental transferDelivery |
| spellingShingle | M.L. Imaz M. Torra D. Soy K. Langorh L. Garcia-Esteve R. Martin-Santos Lithium placental passage at delivery and neonatal outcomes: A retrospective observational study European Psychiatry Neonate lithium Placental transfer Delivery |
| title | Lithium placental passage at delivery and neonatal outcomes: A retrospective observational study |
| title_full | Lithium placental passage at delivery and neonatal outcomes: A retrospective observational study |
| title_fullStr | Lithium placental passage at delivery and neonatal outcomes: A retrospective observational study |
| title_full_unstemmed | Lithium placental passage at delivery and neonatal outcomes: A retrospective observational study |
| title_short | Lithium placental passage at delivery and neonatal outcomes: A retrospective observational study |
| title_sort | lithium placental passage at delivery and neonatal outcomes a retrospective observational study |
| topic | Neonate lithium Placental transfer Delivery |
| url | https://www.cambridge.org/core/product/identifier/S092493382100540X/type/journal_article |
| work_keys_str_mv | AT mlimaz lithiumplacentalpassageatdeliveryandneonataloutcomesaretrospectiveobservationalstudy AT mtorra lithiumplacentalpassageatdeliveryandneonataloutcomesaretrospectiveobservationalstudy AT dsoy lithiumplacentalpassageatdeliveryandneonataloutcomesaretrospectiveobservationalstudy AT klangorh lithiumplacentalpassageatdeliveryandneonataloutcomesaretrospectiveobservationalstudy AT lgarciaesteve lithiumplacentalpassageatdeliveryandneonataloutcomesaretrospectiveobservationalstudy AT rmartinsantos lithiumplacentalpassageatdeliveryandneonataloutcomesaretrospectiveobservationalstudy |