Lithium Pregnancy and Breastfeeding Warnings
Lithium Pregnancy Warnings
One retrospective study of 101 women concluded that rates of recurrence of bipolar disorder during the first 40 weeks after lithium discontinuation were similar for pregnant and nonpregnant women but then sharply increased postpartum.
Lithium has been assigned to pregnancy category D by the FDA. Use of lithium in the first trimester has been associated with congenital defects, particularly cardiac defects such as Ebstein's anomaly, although recent studies (including a prospective study of 148 women on lithium) have concluded that lithium is not a major human teratogen. Lithium toxicity (such as cyanosis, hypotonia, atrial flutter and bradycardia) has been reported in neonates whose mothers took lithium during pregnancy. There is no controlled data in human pregnancy. Lithium should only be given during pregnancy when there are no alternatives and benefit outweighs risk.
Lithium Breastfeeding Warnings
Lithium toxicity in breast- fed infants, including cyanosis, electrocardiogram abnormalities, and hypotonia have also been reported. Some feel this toxicity may be due to the relatively immature kidney function in neonates and is especially likely to occur during times of dehydration. In a study involving 10 nursing mothers (mean lithium dose 850 mg/day; range 600 to 1200 mg/day), breast milk and maternal serum lithium concentrations averaged 0.35 meq/L and 0.76 meq/L, respectively, compared with a mean infant serum concentration of 0.16 meq/L. The breast milk/maternal serum and infant serum/breast milk lithium concentration ratios averaged 0.53 meq/L and 0.50 meq/L, respectively, and the infant/maternal serum lithium concentration ratio was 0.24 meq/L. There were no obvious adverse growth or developmental effects on the infants; however, several instances of elevated thyroid-stimulating hormone (TSH), blood urea nitrogen, and creatinine were reported.
Lithium is excreted into and accumulates in human milk. Lithium achieves serum levels in nursing infants which are one-third to one-half of therapeutic levels. Lithium is considered contraindicated during breast-feeding by the American Academy of Pediatrics (as well as by the manufacturer).
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