>I thought I had heard that the recommendations for taking Lithium while bf
had changed. I was curious, and I asked Thomas Hale, Ph.D, yesterday, about
this. He is author of Medications and Mother's Milk. This is his answer.
THis is not LLLI approved information, but as I say, it is info from a
respected source outside of LLLI.
>
>Kathleen:
>
>I just finished reviewing lithium. I did a current literature search and
>found nothing new. All the breastfeeding data came from a number of older
>publications. Nevertheless, they were well done, and I believe they are
>good data. I changed my current monograph and have enclosed it below. It
>is apparent, that immediately after pregnancy, the levels in mom and
>infant need to be closely monitored, due to flucuations in glomerular
>filtration rate in the kidney. Using Lithium during the first trimester is
>extremely dangerous... all kinds of cardiovascular anomalies result.
>
>
>
>
>Lithium Carbonate
>----------------------------
>Lithium is a potent antimanic drug used in bipolar disorders. Its use in
>the first trimester of pregnancy is associated with a number of birth
>anomalies, particularly cardiovascular. If used during the last two
>trimesters of pregnancy, the dose required is generally increased due to
>the increased renal clearance during pregnancy. Soon after delivery,
>lithium levels should be closely monitored as the renal clearance drops to
>normal in the next several days. Several cases have been reported of
>lithium toxicity in newborns during this period.
>
>Although there have been several reports of side effects, there are no
>reports of severe toxicity. In one study, the milk concentration was
>approximately 40-60% of the maternal serum levels 3-4 weeks postpartum.
>The infant's serum levels were approximately 10% of the maternal serum
>levels. In another study, the milk concentration (0.3 meq/L) was
>approximately 33% of the maternal plasma level at 7 days postpartum.
>
>Shou (1990) reported on eight cases of children breastfed by women
>receiving lithium. The milk:plasma ratio varied from 0.24 to 0.67.
>Concentrations in the mother's serium were 1.5 to 5.6 times those in the
>infant's plasma.
>
> From these studies it is apparent that lithium can permeate milk and is
>absorbed by the breastfed infant. If the infant continues to breastfeed,
> it is strongly suggested that the infant be closely monitored for serium
>lithium levels. In addition, because lithium may block the release of
>thyroxine from the thyroid, occassional thyroid testing may be required in
>breastfeeding infants.
>
>
>Regards
>
>Tom Hale
>
Kathleen B. Bruce, BSN, IBCLC, LLLeader, co-owner Lactnet, LLLOL, Corgi-L
LACTNET WWW site: http://www.mcs.com/~auerbach/lactation.html
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