Is It ‘Safe’ to Breastfeed While on Bipolar Medication?

Highlights:

• Many studies suggest that it is safe for mothers taking lithium to breastfeed their infants. However, more research is needed to validate these findings
• Studies to determine the safety of lithium in breastfed babies are few. Therefore, better designed and larger studies are needed in the future to fill this gap and gain more clarity
• Lithium is the gold standard of care and treatment of choice to treat bipolar disorder, which affects approximately 22 million women worldwide. It is beneficial in preventing manic episodes and psychotic symptoms post-delivery

Women with bipolar disorder taking medications like lithium wonder if breastfeeding while on the medication is safe for their babies. The risk-benefit balance of continuing lithium treatment in breastfeeding women is still being debated and there are no clear answers. Following a recent review of literature by Northwestern University, the authors conclude that more research is necessary to determine the safety of breastfeeding for babies whose mothers are on lithium for bipolar disorder. The review will appear in the Journal of Psychiatry.

For the review, the study team screened 441 studies for eligibility, reviewed 230 studies that satisfied their eligibility criteria and selected 12 studies, that included a total of 37 patient case studies.

To Continue Or Discontinue Lithium While Breastfeeding?

• Women typically suffer from bipolar disorder during their reproductive years and pregnancy and post–delivery period are times when there is a high risk of relapse or worsening of the condition can occur.
• Untreated bipolar disorder is linked to unfavorable birth outcomes for both the mother and her baby, such as small babies, preterm birth and increased risk of maternal death due to suicide
• The risks of breastfeeding while on lithium remains largely unclear, but the risks of stopping lithium treatment have been studied widely and can cause worsening of the illness in the mother and affect her ability to bond with and take care of her baby
• Also for the baby, the benefits of breast milk could outweigh the risk of lithium exposure

Thus, the decision to continue lithium treatment for women after delivery should be made keeping in mind the best interests of both the mother and her baby.

"This is a highly controversial topic, and expert recommendations vary, but the truth is it's 2019, and we still don't have the evidence to back up any of the fears about lithium use and breastfeeding," said senior author Dr. Crystal Clark, assistant professor of psychiatry and behavioral sciences and obstetrics and gynecology at Northwestern University Feinberg School of Medicine and a practicing Northwestern Medicine psychiatrist.

• More well-designed studies should be done in the future to obtain clearer answers
• Until then the safety of continuing lithium in breastfeeding mothers and the potentially harmful effects on the baby must be reviewed on a case to case basis

"There are few absolutes when it comes to managing illness while breastfeeding," Clark said. "It's not one size fits all."

The study authors also feel that the stigma attached to mental illness perhaps makes physicians reluctant to acknowledge the importance of drug treatment for the overall health and mental well being of mothers with mental illness.

In summary, more studies are needed to establish the safety of breast milk in babies whose mothers are taking lithium for bipolar disorder.

Future Plans

Clark is planning future studies to examine the amount of lithium in breast milk and how much lithium is actually ingested by babies and the potential effects of lithium on development during childhood.

Reference:

1. Risk-Benefit Assessment of Infant Exposure to Lithium through Breast Milk: A Systematic Review of the Literature - (https://doi.org/10.1080/09540261.2019.1586657)

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Source-Medindia