Data Insufficient for Safety of Lithium During Breastfeeding

There is variability in data relating to the safety of lithium during breastfeeding, according to a review published in the International Review of Psychiatry.

Rebecca L. Newmark, from Northwestern University in Chicago, and colleagues conducted a systematic review of the literature to examine the degree of lithium exposure through breast milk and potential risk to the infant. Articles that included at least one maternal serum/plasma and/or breast milk lithium concentration and infant serum/plasma lithium concentration were included.

The researchers identified 441 articles and reviewed 230; of these, 12 case reports were selected for inclusion. Lithium transfer to the infant from breast milk was variable; in some cases, transfer was less than the complete placental transfer of lithium shown by the umbilical cord-to-maternal serum lithium concentration rate at delivery. The infant-to-maternal or infant-to-breast milk concentration ratio was frequently used as measure of safety; however, these ratios vary and there is a lack of demonstrated association with adverse effects. In three cases, adverse effects were reported in infants exposed to lithium in breast milk, but these cases were confounded by other factors such as concomitant medication exposure.

"I don't see the same breastfeeding fear with women taking medications for other illnesses such as seizure disorders," a coauthor said in a statement. "There is some stigma related to mental illness that deters physicians from considering it as a vital treatment for the health of their postpartum mothers with mental illness."

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