Perinatal Mental Health Clinic-BCN Unit, Department of Psychiatry and Psychology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Medicine, Institute of Neuroscience, University of Barcelona (UB), Barcelona, Spain.
Pharmacology and Toxicology Laboratory, Biochemistry and Molecular Genetics Service, Biomedical Diagnostic Center (CBD), Hospital Clínic, IDIBAPS, Department of Medicine, UB, Barcelona, Spain.
J Affect Disord. 2024 Dec 1;366:326-334. doi: 10.1016/j.jad.2024.08.140. Epub 2024 Aug 24.
It has been suggested that a 30-50 % lithium dose reduction or lithium discontinuation 24-48 h before delivery could minimize neonatal complications. We investigated the maternal lithemia changes around delivery after a brief discontinuation, the placental transfer of lithium at delivery, and the association between neonatal lithemia at delivery and acute neonatal outcomes.
A retrospective observational cohort study was conducted in a teaching hospital (November/2006-December/2018). Data was extracted from the medical records. We included psychopathologically stable women, with a singleton pregnancy, treated with lithium in late pregnancy, with at least one maternal and neonatal lithemia at delivery. Lithium was discontinued 12 h before a scheduled caesarean section or induction, or at admission day to hospital birth; and restarted 6-12 h post.
Sixty-six mother-infant pairs were included, and 226 maternal and 66 neonatal lithemias were obtained. We found slight maternal lithemia fluctuations close to 0.20 mEq/L, and early postpartum relapse of 6 %. The mean (SD) umbilical cord/mother intrapartum lithemia ratio was 1.10 (0.17). Fifty-six percent of neonates presented transient acute complications. Neonatal hypotonia was the most frequent outcome (N = 15). Mean lithemia were 0.178 mEq/L higher in those with hypotonia than in those without (p = 0.028).
It is a retrospective cohort of a moderate sample size of healthy uncomplicated pregnancies and results cannot be generalized to all pregnant treated with lithium.
Lithium transfers completely across the placenta. A brief predelivery lithium discontinuation was associated with slight maternal lithemia fluctuations. Neonates exposed intrautero to lithium present frequent but transient acute effects.
有研究建议在分娩前 24-48 小时减少 30-50%的锂剂量或停止锂治疗，可以将新生儿并发症降到最低。我们研究了短暂停药后分娩时产妇血锂浓度的变化、锂在分娩时向胎盘的转移，以及分娩时新生儿血锂浓度与新生儿急性结局之间的关系。
这是一项在教学医院进行的回顾性观察队列研究（2006 年 11 月至 2018 年 12 月）。从病历中提取数据。我们纳入了精神稳定的、接受锂治疗的单胎妊娠孕妇，且至少有一次分娩时的产妇和新生儿血锂浓度。锂在计划行剖宫产或引产前 12 小时停止，或在入院当天开始分娩时停止；产后 6-12 小时重新开始。
共纳入 66 对母婴，获得 226 次产妇血锂浓度和 66 次新生儿血锂浓度。我们发现，产妇血锂浓度在接近 0.20mEq/L 的水平略有波动，且产后 6%的患者复发。脐带/产妇分娩时血锂浓度比值的平均值（标准差）为 1.10（0.17）。56%的新生儿出现短暂的急性并发症。最常见的新生儿并发症是新生儿低张力（N=15）。低张力新生儿的血锂浓度比无低张力新生儿高 0.178mEq/L（p=0.028）。
这是一项回顾性队列研究，样本量适中，且纳入的是健康、无并发症的妊娠，因此研究结果不能推广到所有接受锂治疗的孕妇。
锂完全穿过胎盘转移。分娩前短暂停药与产妇血锂浓度略有波动有关。在宫内暴露于锂的新生儿会出现频繁但短暂的急性影响。
