More research, education needed to help patients who want to breastfeed while on lithium
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Key takeaways:
- Of 18 cases of lithium use in the postpartum period, 39% of patients provided breastmilk to their infants.
- No adverse events were reported among four infants with lithium exposure from breastmilk.
NEW YORK — Although guidelines have historically advised against lithium use while breastfeeding, there is a “clear need” for more research and monitoring guidance for patients who would like to breastfeed while on lithium.
“We should get a more multidisciplinary team together — even before the delivery of the baby — so the patient and all of their care providers can work together to support the patient if they would like to breastfeed,” Megan N. Kummerlowe, DO, a fourth-year resident in psychiatry at the Mayo Clinic in Rochester, Minnesota, told Healio at the American Psychiatric Association annual meeting.
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To determine breastfeeding rates for patients using lithium as well as associated infant adverse events, Kummerlowe and colleagues conducted a retrospective chart review at the Mayo Clinic from 2013 to 2023. They identified 18 cases of lithium use in the postpartum period (mean age at delivery, 30.5 years; 95% white), with 39% of those patients providing breastmilk to an infant.
According to results presented in a poster, 61% started using lithium before conception, 28% started in the postpartum period and 11% started during pregnancy. The most common diagnosis was bipolar I (67%), followed by bipolar II (28%) and postpartum psychosis (5%). Seventy-eight percent took lithium once daily.
Of those who initiated lithium before conception, 54% breastfed, while 20% of those who initiated lithium in the postpartum period breastfed.
No adverse events were reported among four infants with lithium exposure from breastfeeding, indicating that lithium in breastmilk may be tolerated in healthy full-term infants with appropriate monitoring.
“Given the importance of lithium as a mood stabilizer, there is a clear need for ongoing research and monitoring guidance to better support patients who would like to breastfeed while on lithium,” researchers wrote.
“This has been advised against historically, but the recent data is reassuring,” Kummerlowe said. “I was surprised that this has been happening in our institution and going really well and despite that, patients still receive conflicting information.”