Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Obstetrics and Gynaecology, Division Obstetrics and Fetal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Bipolar Disord. 2023 May;25(3):181-190. doi: 10.1111/bdi.13297. Epub 2023 Jan 20.
Lithium is often continued during pregnancy to reduce the risk of perinatal mood episodes for women with bipolar disorder. However, little is known about the effect of intrauterine lithium exposure on brain development. The aim of this study was to investigate brain structure in children after intrauterine exposure to lithium.
Participants were offspring, aged 8-14 years, of women with a diagnosis of bipolar spectrum disorder. In total, 63 children participated in the study: 30 with and 33 without intrauterine exposure to lithium. Global brain volume outcomes and white matter integrity were assessed using structural MRI and diffusion tensor imaging, respectively. Primary outcomes were total brain, cortical and subcortical gray matter, cortical white matter, lateral ventricles, cerebellum, hippocampus and amygdala volumes, cortical thickness, cortical surface area and global fractional anisotropy, and mean diffusivity. To assess how our data compared to the general population, global brain volumes were compared to data from the Generation R study (N = 3243).
In our primary analyses, we found no statistically significant associations between intrauterine exposure to lithium and structural brain measures. There was a non-significant trend toward reduced subcortical gray matter volume. Compared to the general population, lithium-exposed children showed reduced subcortical gray and cortical white matter volumes.
We found no differences in brain structure between lithium-exposed and non-lithium-exposed children aged 8-14 years following correction for multiple testing. While a rare population to study, future and likely multi-site studies with larger datasets are required to validate and extend these initial findings.
对于患有双相情感障碍的女性，为了降低围产期情绪发作的风险，常常在孕期继续使用锂。然而，人们对于子宫内锂暴露对大脑发育的影响知之甚少。本研究旨在调查子宫内暴露于锂的儿童的大脑结构。
参与者为女性双相情感障碍患者的后代，年龄 8-14 岁。共有 63 名儿童参与了这项研究：30 名儿童在子宫内暴露于锂，33 名儿童未暴露于锂。使用结构 MRI 和弥散张量成像分别评估整体脑容量和白质完整性。主要结局为全脑、皮质和皮质下灰质、皮质白质、侧脑室、小脑、海马和杏仁核体积、皮质厚度、皮质表面积和整体各向异性分数和平均弥散系数。为了评估我们的数据与一般人群相比如何，将全脑容量与 Generation R 研究的数据（N=3243）进行了比较。
在我们的主要分析中，我们没有发现子宫内暴露于锂与结构脑测量之间存在统计学上显著的关联。亚皮质灰质体积有减少的趋势，但没有统计学意义。与一般人群相比，锂暴露儿童的皮质下灰质和皮质白质体积减少。
在进行多次测试校正后，我们没有发现 8-14 岁锂暴露和非锂暴露儿童的大脑结构存在差异。虽然这是一个罕见的研究人群，但需要未来和可能的多中心研究，以扩大数据集来验证和扩展这些初步发现。
