title: Lithium in breast milk and nursing infants: clinical implications.
abstract: OBJECTIVE
  Current practice guidelines discourage use of lithium during breast-feeding, despite limited data. This study aimed to quantify lithium exposure in nursing infants.
  
  
  METHODS
  In 10 mother-infant pairs, the authors obtained assays of lithium in maternal serum, breast milk, and infant serum and indices of infant renal and thyroid function.
  
  
  RESULTS
  Maternal serum, breast milk, and infant serum daily trough concentrations of lithium averaged 0.76, 0.35, and 0.16 meq/liter, respectively, each lithium level lower than the preceding level by approximately one-half. No serious adverse events were observed, and elevations of thyroid-stimulating hormone, blood urea nitrogen, and creatinine were few, minor, and transient.
  
  
  CONCLUSIONS
  Serum lithium levels in nursing infants were low and well tolerated. No significant adverse clinical or behavioral effects in the infants were noted. These findings encourage reassessment of recommendations against lithium during breast-feeding and underscore the importance of close clinical monitoring of nursing infants.
authors.affiliation: Perinatal and Reproductive Psychiatry Clinical Research Program, Department of Psychiatry, Massachusetts General Hospital, Simches Research Bldg., Second Fl., Suite 2200, 185 Cambridge St., Boston, MA 02114, USA. aviguera@partners.org
authors.forename: Adele C
authors.initials: AC
authors.lastname: Viguera
authors.forename: D Jeffrey
authors.initials: DJ
authors.lastname: Newport
authors.forename: James
authors.initials: J
authors.lastname: Ritchie
authors.forename: Zachary
authors.initials: Z
authors.lastname: Stowe
authors.forename: Theodore
authors.initials: T
authors.lastname: Whitfield
authors.forename: Juliana
authors.initials: J
authors.lastname: Mogielnicki
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Baldessarini
authors.forename: Amanda
authors.initials: A
authors.lastname: Zurick
authors.forename: Lee S
authors.initials: LS
authors.lastname: Cohen
mesh_terms: D001714:Bipolar Disorder / Q000097:blood / Q000188:drug therapy*; D001806:Blood Urea Nitrogen; D001942:Breast Feeding; D003401:Creatine / Q000097:blood; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn / Q000097:blood*; D007677:Kidney Function Tests; D007774:Lactation / Q000097:blood; D018020:Lithium Compounds / Q000009:adverse effects / Q000032:analysis* / Q000097:blood*; D008431:Maternal-Fetal Exchange; D008895:Milk, Human / Q000737:chemistry*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000188:drug therapy*; D011644:Puerperal Disorders / Q000097:blood / Q000188:drug therapy; D013972:Thyrotropin / Q000097:blood
chemical_list: D018020:Lithium Compounds; D013972:Thyrotropin; D003401:Creatine