Lithium in breast milk transiently affects the renal electrolytic balance of infants

Ahmed, Irfan; Khan, Muhammad Saleem; Ma, Victor; Magsi, Hina; Gunawan, Renardi; Ilyas, Abdul-Mojeed Olabisi; Lashari, Najeeb Ur Rehman; Wassan, Naveed; Paidi, Santosh Kumar; Ali, Zulfiqar; Law, Anthony; Zhang, Yanpeng; Cho, William C.; Alda, Martin; Barman, Ishan; Lau, Condon

doi:10.1111/bdi.13275

Cited by 2 publications

References 56 publications

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High lithium concentration at delivery is a potential risk factor for adverse outcomes in breastfed infants: a retrospective cohort study

Whaites Heinonen,

Tötterman,

Bäck

et al. 2023

Int J Bipolar Disord

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Background Neonatal effects of late intrauterine and early postpartum exposure to lithium through mother’s own milk are scarcely studied. It is unclear whether described symptoms in breastfed neonates are caused by placental lithium transfer or postnatal exposure to lithium through breastfeeding. We aimed to investigate lithium clearance and neonatal morbidity in breastfed infants with high versus low serum lithium concentrations at birth. Methods This retrospective study focused on breastfed infants to women treated with lithium during and after pregnancy, born between 2006 and 2021 in Stockholm, Sweden. Information on serum lithium concentrations and adverse neonatal outcomes was obtained from medical records. Neonatal symptoms and lithium clearance were compared between a high exposure group (HEG, lithium concentrations ≥ 0.6 meq/l) and a low exposure group (LEG, < 0.6 meq/l). Results A total of 25 infant-mother dyads were included. Median lithium serum concentration at birth was 0.90 meq/l in the HEG as compared with 0.40 meq/l in the LEG (p < 0.05). The difference was still significant at follow-up (0.20 meq/l vs 0.06 meq/l, p < 0.05), despite reduction in maternal dose. The rate of neonatal symptoms was 85.7% in HEG and 41.2% in LEG (p = 0.08) at birth and 28.6% vs 11.8% at follow-up (p = 0.55). Furthermore, 28.6% of infants in HEG were admitted to neonatal care, vs 5.9% in LEG (p = 0.19). Two infants in the HEG had therapeutic lithium levels at follow-up. All infants with symptoms at follow-up were either in the HEG or exposed to additional psychotropic medication. Conclusions Neonatal symptoms are common after late intrauterine lithium exposure, however transient, treatable and mostly mild. In this study, a high lithium concentration at birth was a risk factor for an increased lithium level at follow-up. Polypharmacy may constitute an additional risk factor. This study suggests that the late intrauterine exposure to lithium might add to the adverse effects in lithium-exposed, breastfed infants. Consequently we recommend breastfed infants with therapeutic lithium concentrations at birth to be followed up promptly to avoid lithium toxicity.

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High lithium concentration at delivery is a potential risk factor for adverse outcomes in breastfed infants: a retrospective cohort study

Whaites Heinonen,

Tötterman,

Bäck

et al. 2023

Int J Bipolar Disord

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Neutralizing and decoupling the effects of lithium medication

Ahmed,

Khan,

Magsi

et al. 2024

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Lithium-induced hypothyroidism in the neonate is a growing concern for lactating mothers. Maternal hypothyroidism in the postpartum period could lead to hypothyroidism in the infant via maternal compromised thyroid hormones (likely T4) in breast milk, and lithium in breast milk could have a direct effect on the neonatal thyroid axis. We have investigated lactating dams and pups, lithium-treated, with and without iodine supplement and control dams. We employed Enzym-linked immunosorbent assay and inductively coupled plasma mass spectrometry to assess hormone profiles and intrathyroidal iodine content. The mechanism for supplemented iodine uptake in the presence of lithium is hypothesized by change in membrane potential across the blood vessel and follicular cell(lactocyte) caused by variation in the gradient concentration of negative iodide ion, positive lithium, sodium, and potassium ions. Interestingly, lithium administered directly to pups from control mothers (average dose 900 mg/50kg/24 hours), did not affect their weight, thyroid hormones, blood urea, and intrathyroidal iodine content despite traces of lithium found in their blood and thyroid. The iodine pathway in presence of lithium content in both thyroid follicular cell and lactocyte has been regulated by gradient concentration of negative (iodide) and positive ions (lithium, potassium, and sodium). The results also demonstrate that lithium administration in lactating dams alters thyroid hormones (T4) and blood urea in both dams and pups, which could be reversed by iodine supplement. In future, supplementing iodine may be potentially useful in clinical practices to address the neonate concerns of lactating mothers and their infants either caused by prolonged lithium medication or maternal iodine deficiency.

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Lithium in breast milk transiently affects the renal electrolytic balance of infants

Cited by 2 publications

References 56 publications

High lithium concentration at delivery is a potential risk factor for adverse outcomes in breastfed infants: a retrospective cohort study

High lithium concentration at delivery is a potential risk factor for adverse outcomes in breastfed infants: a retrospective cohort study

Neutralizing and decoupling the effects of lithium medication

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