Dose response relationship between lithium serum levels during pregnancy and birth outcomes

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica Pub Date : 2024-01-18 DOI:10.1111/acps.13663

Lisanne Schrijver, Astrid M. Kamperman, Hilmar Bijma, Inge L. van Kamp, Richard Wesseloo, Witte J. G. Hoogendijk, Veerle Bergink, Eline M. P. Poels

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Abstract

Introduction

Lithium use during pregnancy reduces the risk of mood episodes in the perinatal period for women with bipolar disorder. Some previous studies found deleterious effects of intrauterine lithium exposure on birth outcomes, yet little is known about a dose response relationship. The current study investigated the influence of maternal lithium serum levels on birth outcomes.

Methods

This retrospective observational cohort study included women with a bipolar spectrum disorder who were referred to a specialized psychiatric and obstetric outpatient clinic from 2003 to 2019 and used lithium during the entire pregnancy. For 101 pregnancies at least one lithium level during pregnancy was available. A weighted average lithium level was calculated for the entire pregnancy, as well as for each trimester. Detailed information on maternal, obstetric and neonatal outcomes were retrieved from the medical records. Linear and logistic regression models were used to investigate the association between weighted average lithium level and pregnancy duration, birth weight percentiles, preterm birth and large for gestational age births (LGA). In subsequent exploratory analyses, we studied the role of thyroid-stimulating hormone (TSH) and thyroxine (T4) as a mediator in the found associations.

Results

The weighted average lithium serum level during pregnancy was negatively associated with pregnancy duration and positively with preterm birth, but not with birth weight percentile or LGA. In exploratory analyses, TSH and T4 did not mediate the association between average lithium serum level and pregnancy duration.

Conclusion

The results of this cohort study during pregnancy indicate a dose response relationship between maternal lithium serum levels and pregnancy duration.

Abstract Image

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孕期锂血清水平与分娩结果之间的剂量反应关系。

简介孕期使用锂可降低躁郁症妇女围产期情绪发作的风险。之前的一些研究发现，宫内锂暴露会对出生结果产生有害影响，但对剂量反应关系却知之甚少。本研究调查了母体锂血清水平对分娩结局的影响：这项回顾性观察队列研究纳入了 2003 年至 2019 年期间转诊至精神科和产科专科门诊并在整个孕期使用锂的双相情感障碍女性。其中 101 名孕妇在怀孕期间至少使用过一次锂。我们计算了整个孕期以及每个孕期的加权平均锂含量。有关孕产妇、产科和新生儿结局的详细信息均来自医疗记录。我们使用线性和逻辑回归模型来研究加权平均锂含量与孕期、出生体重百分位数、早产和大胎龄新生儿（LGA）之间的关系。在随后的探索性分析中，我们研究了促甲状腺激素（TSH）和甲状腺素（T4）作为中介因素在所发现的关联中的作用：结果：孕期加权平均锂血清水平与孕期长短呈负相关，与早产呈正相关，但与出生体重百分位数或 LGA 无关。在探索性分析中，促甲状腺激素（TSH）和甲状腺素（T4）并不介导平均锂血清水平与妊娠持续时间之间的关系：这项孕期队列研究的结果表明，母体锂血清水平与妊娠持续时间之间存在剂量反应关系。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Psychiatrica Scandinavica 医学-精神病学

CiteScore

11.20

自引率

3.00%

发文量

135

审稿时长

6-12 weeks

期刊介绍： Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.