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Imaz ML, Langohr K, Torra M, Soy D, García-Esteve L, Martin-Santos R. Neonatal Feeding Trajectories in Mothers With Bipolar Disorder Taking Lithium: Pharmacokinetic Data. Front Pharmacol 2021; 12:752022. [PMID: 34630122 PMCID: PMC8493120 DOI: 10.3389/fphar.2021.752022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: Women who take lithium during pregnancy and continue after delivery may choose to breastfeed, formula feed, or mix these options. The aim of the study was to evaluate the neonatal lithium serum concentrations based on these three feeding trajectories. Methods: We followed 24 women with bipolar disorder treated with lithium monotherapy during late pregnancy and postpartum (8 per trajectory). Lithium serum concentrations were determined by an AVL 9180 electrolyte analyser with a 0.10 mEq/L detection limit and a 0.20 mEq/L limit of quantification (LoQ). Results: There was complete lithium placental passage at delivery, with a mean ratio of lithium concentration in the umbilical cord to maternal serum of 1.12 ± 0.17. The median times to LoQ were 6-8, 7-8, and 53-60 days for formula, mixed, and exclusive breastfeeding respectively. The generalized log-rank testing indicated that the median times to LoQ differ according to feeding trajectory (p = 0.037). According to the multivariate analysis-adjusted lithium serum concentrations at birth, times to LoQ are, on average, longer under exclusive breastfeeding (formula, p = 0.015; mixed, p = 0.012). No lithium accumulation was observed in infants under either exclusive or mixed breastfeeding. During the lactation follow-up, there was no acute growth or developmental delays in any neonate or infant. Indeed, lithium concentrations in the three trajectories declined in all cases. However, the time needed to reach the LoQ was much longer for those breastfeeding exclusively. Conclusions: In breastfeed infant no sustained accumulation of lithium and no adverse effects on development or growth were observed.
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Affiliation(s)
- Maria Luisa Imaz
- Perinatal Mental Health Clinic-BCN Unit, Department of Psychiatry and Psychology, Hospital Clínic, Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Institut D’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Department of Medicine, Institute of Neuroscience, University of Barcelona (UB), Barcelona, Spain
| | - Klaus Langohr
- Departament of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Mercè Torra
- Pharmacology and Toxicology Laboratory, Biochemistry and Molecular Genetics Service, Biomedical Diagnostic Center (CBD), Hospital Clínic, IDIBAPS, and Department of Medicine, UB, Barcelona, Spain
| | - Dolors Soy
- Division of Medicine, Pharmacy Service, Hospital Clínic, IDIBAPS, UB, Barcelona, Spain
| | - Luisa García-Esteve
- Perinatal Mental Health Clinic-BCN Unit, Department of Psychiatry and Psychology, Hospital Clínic, Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Institut D’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Department of Medicine, Institute of Neuroscience, University of Barcelona (UB), Barcelona, Spain
| | - Rocio Martin-Santos
- Perinatal Mental Health Clinic-BCN Unit, Department of Psychiatry and Psychology, Hospital Clínic, Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Institut D’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Department of Medicine, Institute of Neuroscience, University of Barcelona (UB), Barcelona, Spain
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Imaz ML, Soy D, Torra M, García-Esteve L, Soler C, Martin-Santos R. Case Report: Clinical and Pharmacokinetic Profile of Lithium Monotherapy in Exclusive Breastfeeding. A Follow-Up Case Series. Front Pharmacol 2021; 12:647414. [PMID: 34248617 PMCID: PMC8264295 DOI: 10.3389/fphar.2021.647414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/13/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Most guidelines advise that women taking lithium should not breastfeed. The variation in transfer is just one reason behind this advice. Objectives: To present clinical and pharmacokinetic data of nine mother–infant pairs exposed to lithium monotherapy during late pregnancy and exclusive breastfeeding at the Perinatal Psychiatric Unit (2006–2018). Methods: We obtained sociodemographic data, medical risk factors, obstetric variables, and family and personal psychiatric history by semi-structured interview, and assessed maternal psychopathology with the Hamilton Depression Rating Scale and Young Mania Rating Scale. A senior neonatologist reviewed neonatal outcomes at birth using the Peripartum Events Scale. Paired maternal and cord blood and infant venous blood samples were collected. During the breastfeeding period, we monitored serum lithium and creatinine concentrations in mother–infant pairs at delivery, and at days 1–5, 7–11, 30, and 60 postpartum, and monthly until 6-months. Results: Lithium equilibrated completely across the placenta [1.13 (0.10), range (1.02–1.30)]. No women presented symptoms of postpartum lithium intoxication, two of the neonates presented transient hypotonia (22%). Lithium exposure was significantly less during breastfeeding than during late pregnancy, and serum lithium concentrations decreased up to 44% overtime from delivery to the first-month, and up to 60% to the third-month postpartum. There was no growth or developmental delay in the follow-up period. One woman had a manic episode with psychotic features at 45 days postpartum. Conclusions: In carefully selected women with bipolar disorder, lithium therapy when breastfeeding can be an appropriate option if coupled with close monitoring of the mother-infant pair.
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Affiliation(s)
- Maria Luisa Imaz
- Perinatal Mental Health Clinic-BCN Unit, Department of Psychiatry and Psychology, Hospital Clínic, Department of Medicine, Institute of Neuroscience, University of Barcelona (UB), Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), and Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Barcelona, Spain
| | - Dolors Soy
- Division of Medicines, Pharmacy Service, Hospital Clínic, IDIBAPS, UB, Barcelona, Spain
| | - Mercé Torra
- Pharmacology and Toxicology Laboratory, Biochemistry and Molecular Genetics Service, Biomedical Diagnostic Center (CBD), Hospital Clínic, IDIBAPS, and Department of Medicine, UB, Barcelona, Spain
| | - Llüisa García-Esteve
- Perinatal Mental Health Clinic-BCN Unit, Department of Psychiatry and Psychology, Hospital Clínic, Department of Medicine, Institute of Neuroscience, University of Barcelona (UB), Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), and Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Barcelona, Spain
| | - Cristina Soler
- Department of Neonatology, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia (ICGON), Hospital Clínic, Barcelona, Spain
| | - Rocio Martin-Santos
- Perinatal Mental Health Clinic-BCN Unit, Department of Psychiatry and Psychology, Hospital Clínic, Department of Medicine, Institute of Neuroscience, University of Barcelona (UB), Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), and Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Barcelona, Spain
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Luisa Imaz M, Martin-Santos R. Lithium and Lactation. ARCH CLIN PSYCHIAT 2020. [DOI: 10.15761/0101-60830000000246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Imaz ML, Torra M, Soy D, García-Esteve L, Martin-Santos R. Clinical Lactation Studies of Lithium: A Systematic Review. Front Pharmacol 2019; 10:1005. [PMID: 31551795 PMCID: PMC6746934 DOI: 10.3389/fphar.2019.01005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/08/2019] [Indexed: 12/21/2022] Open
Abstract
Background: There is substantial evidence that postpartum prophylaxis with lithium lowers the rate of relapse in bipolar disorder. However, it is contraindicated during breastfeeding due to the high variability of the transfer into breast milk. Aims: We conducted a systematic review of the current evidence of studies assessing the transfer of lithium to lactating infants and short-term infant outcomes. Methods: An a priori protocol was designed based on PRISMA guidelines. Searches in PubMed and LactMed were conducted until September 2018. Studies assessing lithium pharmacokinetic parameters and short-term infant outcomes were included. Quality was assessed using a checklist based on international guidelines (i.e., FDA). Results: From 344 initial studies, 13 case reports/series with 39 mother-child dyads were included. Only 15% of studies complied with ≥50% of the items on the quality assessment checklist. Infants breastfeed a mean (SD) of 58.9 (83.3) days. Mean maternal lithium dose was 904 (293) mg/day, corresponding lithium plasma/serum concentration was 0.73(0.26) mEq/L, and breast milk concentration was 0.84(0.14) mEq/L. Mean infant lithium plasma/serum concentration was 0.23(0.26) mEq/L. Twenty-six (80%) infants had concentrations ≤0.30 mEq/L without adverse effects. Eight (20%) showed a transient adverse event (i.e., acute toxicity or thyroid alterations). All of them were also prenatally exposed to lithium monotherapy or polytherapy. Conclusion: The current evidence comes from studies with a degree of heterogeneity and of low-moderate quality. However, it identifies areas of improvement for future clinical lactation studies of lithium and provides support for some clinical recommendations.
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Affiliation(s)
- Maria Luisa Imaz
- Department of Medicine, Institute of Neuroscience, University of Barcelona (UB), Barcelona, Spain
- Unit of Perinatal Mental Health, Department of Psychiatry and Psychology, Hospital Clínic, Institut d´Investigació Mèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mercè Torra
- 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, University of Barcelona, Barcelona, Spain
| | - Dolors Soy
- Division of Medicines, Hospital Clínic, IDIBAPS, Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Lluïsa García-Esteve
- Unit of Perinatal Mental Health, Department of Psychiatry and Psychology, Hospital Clínic, Institut d´Investigació Mèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Rocio Martin-Santos
- Department of Medicine, Institute of Neuroscience, University of Barcelona (UB), Barcelona, Spain
- Department of Psychiatry and Psychology, Hospital Clínic, IDIBAPS, Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Barcelona, Spain
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Oriolo G, Barbosa L, Imaz ML, Garcia L, Borrego S, Parellada E. Plasma levels of oral risperidone during enteral nutrition in a pregnant schizophrenic patient. Ther Adv Psychopharmacol 2015; 5:133-7. [PMID: 26240750 PMCID: PMC4521445 DOI: 10.1177/2045125314567115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Giovanni Oriolo
- Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clinic de Barcelona, Catalonia, Spain
| | - Lucila Barbosa
- Department of Psychiatry, Hospital Provincial del Centenario, Rosário, Argentina
| | - Maria Luisa Imaz
- Perinatal Psychiatric Program, Hospital Clínic de Barcelona, IDIBAPS, Catalonia, Spain
| | - Luisa Garcia
- Perinatal Psychiatric Program, Hospital Clínic de Barcelona, IDIBAPS, Catalonia, Spain
| | - Sergi Borrego
- Department of Neurology, Hospital Clínic de Barcelona, Catalonia, Spain
| | - Eduard Parellada
- Barcelona Clinic Schizophrenia Unit (BCSU), Hospital Clínic de Barcelona, Universitat de Barcelona, IDIBAPS, CIBERSAM, Catalonia, Spain
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Alvarez-Segura M, Garcia-Esteve L, Torres A, Plaza A, Imaz ML, Hermida-Barros L, San L, Burtchen N. Are women with a history of abuse more vulnerable to perinatal depressive symptoms? A systematic review. Arch Womens Ment Health 2014; 17:343-57. [PMID: 25005865 DOI: 10.1007/s00737-014-0440-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 06/11/2014] [Indexed: 01/29/2023]
Abstract
The objective of this paper is to examine the association between maternal lifetime abuse and perinatal depressive symptoms. Papers included in this review were identified through electronic searches of the following databases: Pubmed Medline and Ovid, EMBASE, PsycINFO, and the Cochrane Library. Each database was searched from its start date through 1 September 2011. Keywords such as "postpartum," "perinatal," "prenatal," "depression," "violence," "child abuse," and "partner abuse" were included in the purview of MeSH terms. Studies that examined the association between maternal lifetime abuse and perinatal depression were included. A total of 545 studies were included in the initial screening. Forty-three articles met criteria for inclusion and were incorporated in this review. Quality of articles was evaluated with the Newcastle-Ottawa-Scale (NOS). This systematic review indicates a positive association between maternal lifetime abuse and depressive symptoms in the perinatal period.
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Affiliation(s)
- M Alvarez-Segura
- Department of Psychiatry and Psychology, CIBERSAM, Hospital Sant Joan de Déu, Barcelona, Spain,
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Roca A, Imaz ML, Torres A, Plaza A, Subirà S, Valdés M, Martin-Santos R, Garcia-Esteve L. Unplanned pregnancy and discontinuation of SSRIs in pregnant women with previously treated affective disorder. J Affect Disord 2013; 150:807-13. [PMID: 23566335 DOI: 10.1016/j.jad.2013.02.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 02/26/2013] [Accepted: 02/27/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To identify the factors associated with discontinuation of selective serotonin reuptake inhibitors (SSRIs) in pregnant women and to determine the rates of SSRI reintroduction during pregnancy. METHOD A prospective study was conducted in the Perinatal Psychiatry Service of the Hospital Clínic in Barcelona. The total sample comprised 132 consecutive pregnant women with depressive or anxiety disorder (DSM-IV criteria), seen between January 2005 and December 2008 and who were receiving SSRIs at the time of conception. Clinical, psychometric and socio-demographic variables were collected at the first visit. All women were assessed during treatment with the Edinburgh Perinatal Depression Scale (EPDS) and the Spielberger State-Trait Anxiety Inventory (STAI). Dose and type of antidepressant were recorded at each visit during pregnancy. RESULTS Seventy women (53%) discontinued SSRI treatment upon confirmation of pregnancy. Socio-demographic, obstetric and psychiatric variables did not differ significantly between women who maintained and women who discontinued treatment. Only unplanned pregnancy was associated with a greater risk of discontinuation (OR=2.7, 95% CI=1.34-5.52). Women who discontinued treatment also had higher EPDS and STAI scores in the first visit and prenatal visit (34-36 weeks) (p<.05). Of the 70 women who discontinued treatment, 57.1% (N=40) reintroduced treatment, almost half of these in the first trimester of pregnancy. CONCLUSIONS Unplanned pregnancy was a risk factor for abrupt discontinuation of SSRIs upon confirmation of pregnancy in women with depressive or anxiety disorder. More than half the pregnant women who discontinued SSRIs reintroduced antidepressant therapy during pregnancy.
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Affiliation(s)
- A Roca
- Perinatal Psychiatry Service, Department of Psychiatry, Hospital Clínic Universitari, Barcelona, Spain.
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Roca A, Garcia-Esteve L, Imaz ML, Torres A, Hernández S, Botet F, Gelabert E, Subirà S, Plaza A, Valdés M, Martin-Santos R. Obstetrical and neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitors: the relevance of dose. J Affect Disord 2011; 135:208-15. [PMID: 21890210 DOI: 10.1016/j.jad.2011.07.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 07/24/2011] [Accepted: 07/24/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effects of prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) on obstetrical and neonatal outcomes. METHOD A case-control study was conducted to compare perinatal outcomes among pregnant women with affective disorder (DSM-IV criteria) and who received SSRIs during pregnancy with those of women without an active psychiatric disorder during pregnancy who were non-exposed to antidepressants during pregnancy. Each case was matched to two controls for maternal age (± 2 years) and parity. RESULTS A total of 252 women were enrolled in the study, 84 exposed and 168 non-exposed. Demographic and clinical characteristics did not differ significantly between the groups. The rates of prelabor rupture of membranes, induction of labor and cesarean delivery were slightly higher but not statistically significant in the exposed group. The mean gestational age at birth was 38.8 (± 1.86) weeks for the exposed group and 39.4 (± 1.52) weeks for the non-exposed group (p=.005). Rates for preterm birth were higher in the exposed group (OR=3.44, 95% CI=1.30-9.11). After stratification for dose, it was found that exposure to a high-dose was associated with lower gestational age (p=.009) and higher rates of prematurity (OR=5.07, 95% CI=1.34-19.23). The differences remained significant after controlling for maternal status and the length of exposure. CONCLUSION Women treated with SSRIs during pregnancy, mainly at high-dose, had an increased risk of preterm birth compared to healthy women of similar age and parity who were not exposed to SSRI during pregnancy.
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Affiliation(s)
- A Roca
- Perinatal Psychiatry Program, Institut Clinic of Neuroscience (ICN), Hospital Clínic, Barcelona, Spain.
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Navinés R, Gómez-Gil E, Martín-Santos R, Martínez de Osaba MJ, Imaz ML, Gastó C. An increased hypothermic response to buspirone in patients with major depression. Psychopharmacology (Berl) 2006; 188:258-60. [PMID: 16941120 DOI: 10.1007/s00213-006-0507-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 07/04/2006] [Indexed: 10/24/2022]
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Blanch J, Martínez-Pallí G, Navinés R, Arcega JM, Imaz ML, Santos P, Faulí A, Bernardo M, Gomar C. Comparative hemodynamic effects of urapidil and labetalol after electroconvulsive therapy. J ECT 2001; 17:275-9. [PMID: 11731729 DOI: 10.1097/00124509-200112000-00007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Urapidil, a postsynaptic alpha 1 -adrenergic antagonist, has been reported to improve intraoperative hemodynamic stability, although it has never been used to prevent the hemodynamic response of electroconvulsive therapy (ECT). This study was designed to evaluate the clinical effectiveness of urapidil, as an alternative to labetalol, in preventing the hemodynamic response of ECT. Twenty-seven patients undergoing a series of six consecutive ECT treatments were studied. Each patient received all three pretreatments twice: no drug, labetalol 0.2 mg/kg, or urapidil 25 mg. Systolic, diastolic, and mean blood pressure and heart rate (HR) were recorded during the awake state, after anesthesia induction, and 1, 2, 5, 10 and 30 minutes after electroencephalographic (EEG) seizure ended. The duration of the EEG convulsion was also recorded. After induction, the HR increased for no drug and urapidil pretreatments, whereas it decreased when labetalol was given. Labetalol and urapidil attenuated the peak increase of blood pressure and returned it to earlier baseline values. There were no differences in the duration of EEG convulsion between the three pretreatments. Urapidil seems to be a good alternative to labetalol for attenuating the hypertensive response to ECT in cases where there is a contraindication to beta-antagonists.
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Affiliation(s)
- J Blanch
- Clinical Institute of Psychiatry and Psychology, Hospital Clínic Universitari de Barcelona, Barcelona, Spain.
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