Research has found a “rule of halves” with lithium concentration in infant serum, breast milk and maternal serum. Lithium is well tolerated in infants with only minor and short lasting lad abnormalities after long exposure.
Breastfeeding is an age-long tradition through which infants survive before they start having other foods. Naturally available breast milk is safe, hygienic and most importantly helps initial growth and development of the child. To make it healthy for the baby during breastfeeding, proper balanced diet should be taken by the mother.
During pregnancy there are chances at least 3-5 % woman may develop a baby with some birth defect. This is background risk for her.In this article we are going to talk about whether exposure to lithium increase chances of these birth defects over the background risk or is it safe.
A Guide for Lithium Side Effects During Breastfeeding
What is Lithium?
Lithium is employed as a medication for bipolar disorder also known as manic depression. It is also used in treating other psychiatric and medical conditions such as seborrhea, overactive thyroid, Grave’s disease and more.
The mechanism of lithium is still unknown but it has been observed that it helps in mental disorders by increasing the activity of chemical messengers in the brain.
Side effects of lithium
- Lithium can cause nausea, diarrhea and dizziness.
- Muscle weakness, fatigue and dazed feeling.
- Fine tremor, frequent urination occur on persist use of lithium.
- Sometimes weight gain and swelling is also seen.
- Lithium is also responsible for causing skin problems like acne, psoriasis.
Therefore, intake of lithium should be controlled carefully.
Lithium during Breastfeeding
Other than lithium exposure to infants, doctors are concerned about the risk to maternal mood caused by sleep disturbance. Even though it has not been studied on population but believed that sleep deprivation could trigger mood episodes in postpartum women with bipolar disorder. The concept of bottle feeding helps others to participate in nighttime feeds and protecting the mother’s sleep. Therefore, doctors usually discourage breastfeeding to mothers taking lithium.
A woman taking regular lithium but wanting to breastfeed has many choices when she approaches postpartum period:
After delivery she may choose to discontinue lithium or switch to mood stabilizer. But from doctor’s point of view the discontinuation or changing over the medication in women with serious illness is not advisable. There maybe even chances that woman responding to lithium may not respond to another stabilizer. And moreover safety data for breastfeeding are lacking in many mood stabilizer.
A woman taking lithium in postpartum period who think of nursing the infant either choose breastfeeding exclusively or partial breastfeeding and partial bottle feeding.
Following factors are to be considered for breastfeeding:
- Stable maternal mood
- A healthy, full term infant
- Proper guidance from the pediatrician for understanding the importance of infant monitoring
- Lithium monotherapy
Drug Levels
Maternal Levels
Lithium levels in breast milk do not characterize breast milk lithium excretion in rigorous manner. In some women lithium in milk was found inversely proportional to the milk volume while the milk to plasma ratio was found to be directly proportional to serum lithium.
Infant Levels
Serum lithium in breastfed infants of mothers taking lithium have ranged from 10 to 50 % of the mother’s serum lithium levels.
Effects in Breastfed Infants
According to old reports, at least 24 infants breastfed during maternal lithium therapy reported without any sign of toxicity whereas in a 5 year old child cyanosis lethargy and ECGG T- wave inversion was observed due to lithium in breast milk.
Effect on Lactation and Breast milk
Serum prolactin is increased due to lithium. Galactorrhea is being seen in women taking lithium carbonate for about 50 days. In some lactation is even ceased on discontinuation of lithium.
Side effects Lithium During Breastfeeding
It is a good medication used in psychiatric disorders. But sometimes nursing interventions include:
- Dry mouth: When the mouth does not make enough saliva.
- Muscle twitching in observed
- Headache, vertigo associated with acrophobia
- Increase in number of white blood cells.
- Decreased memory, weight gain
- Constipation or diarrhea with vomiting can be seen.
These side effects can be passed on to the infant in many cases.
Monitoring Lithium During Breastfeeding
It is Doctor’s responsibility to keep a check on mother during breastfeeding phase. Suffering from restlessness, difficulty during feeding and decreased muscle tone needs the consultation of the doctor. Every individual woman reacts differently to the intake of lithium. However, breastfeeding can be continued when:
- Mother is in a stable maternal mood.
- When mother have full term and healthy infant.
- Pediatrician support in monitoring the medication after the delivery.
Lithium is transmitted in different concentration when mother is breastfeeding. Since the babies are likely to get vulnerable to same side effects it is advised to monitor them every 6 to 8 weeks. Change in thyroid and renal functioning of infant.
The monitoring must include measuring lithium level with the help of:
- A blood test
- Creatinine
- Thyroid Stimulating Hormone (TSH)
- BUN (Blood Urea Nitrogen )
Lithium may even increase prolactin, but do not affect the ability of woman to breastfeed. Breast milk is the basic and important diet for the infant and mother should understand its importance and consult the doctor before she breastfeed the infant.
Precautions
Lithium is associated with birth defects so medication might be changed once pregnancy is reported. Stoppage of the medication abruptly can lead to serious side effects.
While taking lithium helps you stay hydrated and keep cool. The drug can affect the ability to drive and operate machinery. In case of pervious history with thyroid or kidney related problems physician consultation is required.
Thus therapeutic dose of lithium is to be maintained properly.
Conclusion
Research has found a “rule of halves” with lithium concentration in infant serum, breast milk and maternal serum. Lithium is well tolerated in infants with only minor and short lasting lad abnormalities after long exposure. The ideal candidate for continuing lithium during breastfeeding is patient with stable maternal mood, lithium monotherapy and having a healthy Infant with supportive pediatrician.
