Schonewille Noralie N, Terpstra Pleun A, van den Heuvel Maria E N, Van Pampus Maria G, van den Heuvel Odile A, Broekman Birit F P
Department of Psychiatry and Medical Psychology, OLVG, Oosterpark 9, Amsterdam, The Netherlands.
Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Int J Bipolar Disord. 2023 Jul 14;11(1):24. doi: 10.1186/s40345-023-00306-7.
Lithium is the preferred treatment for pregnant women with bipolar disorders (BD), as it is most effective in preventing postpartum relapse. Although it has been prescribed during pregnancy for decades, the safety for neonates and obstetric outcomes are a topic of ongoing scientific debate as previous research has yielded contradicting outcomes. Our study aims to compare (re)admission rates and reasons for admissions in neonates born to women with bipolar disorders (BD) with and without lithium exposure.
A retrospective observational cohort study was conducted in a Dutch secondary hospital (two locations in Amsterdam). Women with BD who gave birth after a singleton pregnancy between January 2011 and March 2021 and their neonates were included. Outcomes were obtained by medical chart review of mothers and neonates and compared between neonates with and without lithium exposure. The primary outcome was admission to a neonatal ward with monitoring, preterm birth, small for gestational age (SGA), 5-minute Apgar scores, neonatal asphyxia, and readmission ≤ 28 days.
We included 93 women with BD, who gave birth to 117 live-born neonates: 42 (36%) exposed and 75 (64%) non-exposed to lithium. There were no significant differences in neonatal admission with monitoring (16.7 vs. 20.0%, p = 0.844). Additionally, preterm birth (7.1 vs. 5.3%), SGA (0.0 vs. 8.0%), 5-minute Apgar scores (means 9.50 vs. 9.51), neonatal asphyxia (4.8 vs. 2.7%) and readmission (4.8 vs. 5.3%) were comparable. Overall, 18.8% of BD offspring was admitted. Women with BD had high rates of caesarean section (29.1%), gestational diabetes (12.8%) and hypertensive disorders of pregnancy (8.5%).
In a sample of neonates all born to women with BD using various other psychotropic drugs, exposure to lithium was not associated with greater risk of neonatal admission to a ward with monitoring compared to non-exposure to lithium, questioning the necessity for special measures after lithium exposure. However, offspring of women with BD was admitted regularly and women with BD have high obstetric risk which require clinical and scientific attention.
锂盐是双相情感障碍（BD）孕妇的首选治疗药物，因为它在预防产后复发方面最为有效。尽管锂盐已在孕期使用了数十年，但由于先前的研究结果相互矛盾，新生儿安全性和产科结局仍是一个持续的科学争论话题。我们的研究旨在比较双相情感障碍（BD）孕妇所生新生儿中，有和没有锂盐暴露史的新生儿再次入院率及入院原因。
在荷兰一家二级医院（阿姆斯特丹的两个院区）开展了一项回顾性观察队列研究。纳入2011年1月至2021年3月期间单胎妊娠分娩的双相情感障碍（BD）孕妇及其新生儿。通过查阅母亲和新生儿的病历获取结局数据，并比较有和没有锂盐暴露史的新生儿的结局。主要结局包括入住新生儿监护病房、早产、小于胎龄儿（SGA）、5分钟阿氏评分、新生儿窒息以及28天内再次入院。
我们纳入了93例双相情感障碍（BD）孕妇，她们共分娩了117例活产新生儿：42例（36%）有锂盐暴露史，75例（64%）无锂盐暴露史。有监护的新生儿入院率无显著差异（16.7%对20.0%，p = 0.844）。此外，早产（7.1%对5.3%）、小于胎龄儿（0.0%对8.0%）、5分钟阿氏评分（均值9.50对9.51）、新生儿窒息（4.8%对2.7%）和再次入院率（4.8%对5.3%）均具有可比性。总体而言，双相情感障碍（BD）孕妇的后代中有18.8%入院。双相情感障碍（BD）孕妇剖宫产率（29.1%）、妊娠期糖尿病发生率（12.8%）和妊娠期高血压疾病发生率（8.5%）均较高。
在一组均为使用各种其他精神药物的双相情感障碍（BD）孕妇所生的新生儿样本中，与未暴露于锂盐的新生儿相比，暴露于锂盐的新生儿入住监护病房的风险并未增加，这对锂盐暴露后采取特殊措施的必要性提出了质疑。然而，双相情感障碍（BD）孕妇的后代经常入院，且双相情感障碍（BD）孕妇产科风险较高，这需要临床和科研关注。
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