A study in The Lancet Psychiatry determined whether women on lithium carbonate for mental illnesses after giving birth is harmful to their newborns.
Breastfeeding is essential for new-born infants after they are born and must be started within the hour the infant is born. This is the way a mother can supply essential nutrients to her infant. Experts have noted that breastfeeding within the initial hours of life is also essential for the bonding between the mother and the infant. Breast milk is produced in the mother during the last few months of pregnancy and contains all the essential nutrients required by the new-born infant for appropriate growth and development of immunity. Substitutes to breast milk may lead to deficiencies in the growth of the new-born and in some cases, can also lead to developmental abnormalities and adverse immune reactions.
The post-natal period is the period where the body of the women recovers after she has given birth. This period lasts about six months but may be longer depending upon the individual woman. Women who had mental disorders before or during pregnancy are prone to develop mental illnesses during their post-natal period, putting them at a high risk for post-partum depression.
Mood-stabilizing drug lithium carbonate has been known to cause harmful effects to babies in the womb
Mothers taking treatment for anxiety during pregnancy should be careful about their drug treatment. Lithium, a known mood stabilizing drug for people who suffer from extreme anxiety, has been known to cause harmful effects to growing foetuses in the wombs of pregnant women that could eventually lead to abortions with complications for the mother.
After pregnancy is over, with the increase in mania and depression during the post-natal phase, lithium carbonate has been shown to have positive effects in improving the mental health of women and helping them bond better with their babies. Although these effects are positive, due to the secretion of lithium from the blood circulation of the mother into the breast milk, there is some speculation that infants feeding on that breast milk might be in danger of lithium toxicity.
Due to this uncertainty in treatment during the post-natal period, Megan Galbally and colleagues decided to explore the effects of lithium carbonate contained in breastmilk on infants. According to their analysis, adults have a higher rate of excreting the lithium from their bodies through their kidneys compared to infants, and therefore adult doses of lithium when exposed to the breastfeeding infant via breast milk could prove to have major side effects. Their study was published in The Lancet Psychiatry.
Positive effects of breastfeeding do not outweigh the negative effects of lithium toxicity in infants
There was a total of 36 women on lithium with their infants that were analysed. Out of these mother-infant pairs, one infant developed a decrease in his muscle tone and was unable to develop the skills required to move his body efficiently as per the conventional developmental milestones. Other infants were reported to have developed thyroid abnormalities with increased or decreased production of the thyroid hormone. Such effects on the thyroid can be fatal as the thyroid hormone has a big role in controlling the basal metabolic rate and fat distribution within the body.
Due to the nature of these results, experts conclude that the positive effects of breastfeeding do not outweigh the negative effects of lithium carbonate in the infant for mothers on an anti-manic or anti-depression management program. They emphasize the need to develop methods to increase mother-infant bonding without breastfeeding, or the prescription of a safer treatment regimen to be able to help women feel positive about their mental health and have confidence in bonding with their newborn infant.
Written by Dr. Apollina Sharma, MBBS, GradDip EXMD
Reference: Galbally, M., Bergink, V., Vigod, S. N., Buist, A., Boyce, P., Chandra, P., … & Howard, L. M. (2018). Breastfeeding and lithium: is breast always best?. The Lancet Psychiatry.