title: Exposure to lithium through drinking water and calcium homeostasis during pregnancy: A longitudinal study.
abstract: There is increasing evidence of adverse health effects due to elevated lithium exposure through drinking water but the impact on calcium homeostasis is unknown. This study aimed at elucidating if lithium exposure through drinking water during pregnancy may impair the maternal calcium homeostasis. In a population-based mother-child cohort in the Argentinean Andes (n=178), with elevated lithium concentrations in the drinking water (5-1660μg/L), blood lithium concentrations (correlating significantly with lithium in water, urine and plasma) were measured repeatedly during pregnancy by inductively coupled plasma mass spectrometry and used as exposure biomarker. Markers of calcium homeostasis included: plasma 25-hydroxyvitamin D3, serum parathyroid hormone (PTH), and calcium, phosphorus and magnesium concentrations in serum and urine. The median maternal blood lithium concentration was 25μg/L (range 1.9-145). In multivariable-adjusted mixed-effects linear regression models, blood lithium was inversely associated with 25-hydroxyvitamin D3 (-6.1nmol/L [95%CI -9.5; -2.6] for a 25μg/L increment in blood lithium). The estimate increased markedly with increasing percentiles of 25-hydroxyvitamin D3. In multivariable-adjusted mixed-effects logistic regression models, the odds ratio of having 25-hydroxyvitamin D3<30nmol/L (19% of the women) was 4.6 (95%CI 1.1; 19.3) for a 25μg/L increment in blood lithium. Blood lithium was also positively associated with serum magnesium, but not with serum calcium and PTH, and inversely associated with urinary calcium and magnesium. In conclusion, our study suggests that lithium exposure through drinking water during pregnancy may impair the calcium homeostasis, particularly vitamin D. The results reinforce the need for better control of lithium in drinking water, including bottled water.
authors.affiliation: Unit of Metals and Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Florencia
authors.initials: F
authors.lastname: Harari
authors.affiliation: Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Agneta
authors.initials: A
authors.lastname: Åkesson
authors.affiliation: Atención Primaria de la Salud, Área Operativa XXIX, Hospital Dr. Nicolás Cayetano Pagano, San Antonio de los Cobres, Salta, Argentina.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Casimiro
authors.affiliation: Unit of Metals and Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ying
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Unit of Metals and Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: Marie.Vahter@ki.se.
authors.forename: Marie
authors.initials: M
authors.lastname: Vahter
mesh_terms: D000293:Adolescent; D000328:Adult; D001118:Argentina; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002118:Calcium / Q000097:blood* / Q000652:urine*; D060766:Drinking Water / Q000032:analysis*; D004781:Environmental Exposure; D005260:Female; D006706:Homeostasis; D006801:Humans; D008094:Lithium / Q000032:analysis / Q000097:blood / Q000378:metabolism* / Q000652:urine; D008137:Longitudinal Studies; D011247:Pregnancy; D014874:Water Pollutants, Chemical / Q000032:analysis / Q000097:blood / Q000378:metabolism* / Q000652:urine; D055815:Young Adult
chemical_list: D015415:Biomarkers; D060766:Drinking Water; D014874:Water Pollutants, Chemical; D008094:Lithium; D002118:Calcium
keywords: Calcium homeostasis; Drinking water; Lithium; Pregnancy; Vitamin D