Lithium placental passage and obstetrical outcome

Implications for clinical management during late pregnancy

Donald J Newport, Adele C. Viguera, Aquila J. Beach, James C. Ritchie, Lee S. Cohen, Zachary N. Stowe

Research output: Contribution to journalArticle

125 Citations (Scopus)

Abstract

Objective: Lithium has been used during pregnancy for more than four decades, but quantification of fetal lithium exposure and clinical correlations of such exposure are limited. The study objectives were to 1) quantify the rate of lithium placental passage, 2) assess any association between plasma concentration of lithium at delivery and adverse perinatal events, and 3) determine whether lithium concentrations can be reduced by briefly suspending therapy proximate to delivery. Method: Maternal blood and umbilical cord blood were obtained at delivery for assay of lithium concentrations, and obstetrical outcome data were collected prospectively for 10 participants. These data were combined with results from MEDLINE and PsycINFO searches that identified 32 cases in which maternal lithium was administered throughout delivery. Statistical analysis of the pooled data was conducted. Results: The ratio of lithium concentrations in umbilical cord blood to maternal blood (mean=1.05, SD=0.13) was uniform across a wide range of maternal concentrations (0.2-2.6 meq/liter). Significantly lower Apgar scores, longer hospital stays, and higher rates of CNS and neuromuscular complications were observed in infants with higher lithium concentrations (>0.64 meq/liter) at delivery. Withholding lithium therapy for 24-48 hours before delivery resulted in a 0.28 meq/liter reduction in maternal lithium concentration. Conclusions: Lithium completely equilibrates across the placenta. Higher lithium concentrations at delivery are associated with more perinatal complications, and lithium concentrations can be reduced by brief suspension of therapy proximate to delivery. Treatment guidelines are proposed to improve neonatal well-being when lithium use is indicated in late pregnancy.

Original languageEnglish (US)
Pages (from-to)2162-2170
Number of pages9
JournalAmerican Journal of Psychiatry
Volume162
Issue number11
DOIs
StatePublished - Nov 2005
Externally publishedYes

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Lithium
Pregnancy
Mothers
Fetal Blood
Statistical Data Interpretation
Apgar Score
Therapeutics
MEDLINE
Placenta
Length of Stay
Suspensions

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Lithium placental passage and obstetrical outcome : Implications for clinical management during late pregnancy. / Newport, Donald J; Viguera, Adele C.; Beach, Aquila J.; Ritchie, James C.; Cohen, Lee S.; Stowe, Zachary N.

In: American Journal of Psychiatry, Vol. 162, No. 11, 11.2005, p. 2162-2170.

Research output: Contribution to journalArticle

Newport, Donald J ; Viguera, Adele C. ; Beach, Aquila J. ; Ritchie, James C. ; Cohen, Lee S. ; Stowe, Zachary N. / Lithium placental passage and obstetrical outcome : Implications for clinical management during late pregnancy. In: American Journal of Psychiatry. 2005 ; Vol. 162, No. 11. pp. 2162-2170.
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