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I am posting this on behalf of a friend with her permission. She suffers from manic episodes, is currently pregnant and is interested in breastfeeding. When she found out she was pregnant she stopped taking her Lithium prescription under the direction of her psychiatrist. She has not suffered a manic episode since becoming pregnant but fears after the baby arrives that it might start up. She would like to be able to go back on Lithium after the baby is born but is unsure of the risk to her newborn if she chooses to breastfeed. Is this something that she could do? She will be talking to her psychiatrist about it but wanted me to get any information I could for her before then.
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Dear chels4144,
Dr. Hale states that lithium readily transfers to the infant via milk. Infant plasma levels can be significant. If closely followed, most infants could continue to breastfeed, but close followup by attending physicians is mandatory. If the infant continues to breastfeed, it is strongly suggested that the infant be closely monitored for serum lithium levels, and BUN/creatinine after 6 weeks or so. Levels drawn too early ( 7 days) may only reflect in utero exposure. A number of studies of lithium suggest that lithium administration is not an absolute contraindication to breastfeeding, if the physician monitors the infant closely for elevated plasma lithium. Current studies, as well as unpublished experience, suggest that the infant's plasma levels rise to about 30-40% of the maternal level, most often without untoward effects in the infant. Use with great caution and medical support. Hope this information is helpful.
Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center
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