Florencia Harari1, Margareta Langeén1, Esperanza Casimiro2, Matteo Bottai3, Brita Palm1, Helena Nordqvist1, Marie Vahter4. 1. Unit of Metals and Health, Institute of Environmental Medicine, Karolinska Institutet, Box 210, 17177 Stockholm, Sweden. 2. Supervisor Intermedio de Atención Primaria de la Salud, Área Operativa XXIX, Hospital Dr. Nicolás Cayetano Pagano, San Antonio de los Cobres, 4411 Salta, Argentina. 3. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Box 210, 17177 Stockholm, Sweden. 4. Unit of Metals and Health, Institute of Environmental Medicine, Karolinska Institutet, Box 210, 17177 Stockholm, Sweden. Electronic address: Marie.Vahter@ki.se.
Abstract
BACKGROUND: Lithium, used for treating bipolar disease, crosses freely the placenta and is classified as teratogenic. It is unclear to what extent environmental lithium exposure may affect fetal growth and development. OBJECTIVES: To elucidate potential effects of lithium exposure through drinking water during pregnancy on fetal size. METHODS: We developed a prospective population-based mother-child cohort (N=194) in an area with highly varying drinking water lithium concentrations (5-1600 μg/L) in northern Argentinean Andes. Blood and urinary lithium concentrations (sampled repeatedly during pregnancy) were measured using inductively coupled plasma mass spectrometry. We measured fetal size by ultrasound in second and third trimesters, and weight, length and head circumference at birth. Multivariable models were used to examine associations between lithium exposure (continuous and in tertiles) and fetal size measures. RESULTS: Lithium in maternal blood (median 25; range 1.9-145 μg/L) and urine (1645; 105-4600 μg/L) was inversely associated (apparently linearly) with all fetal measures (body, head and femur) in the second trimester, and with birth length (β -0.53 cm per 25 μg/L increase in blood lithium, 95%CI -1.0; -0.052). An increase of 100 μg/L in blood was associated with 2 cm shorter newborns (about one standard deviation). CONCLUSIONS: Lithium exposure through drinking water was associated with impaired fetal size and this seemed to be initiated in early gestation. Further studies are warranted to confirm causality and to understand the mechanisms. If confirmed, these findings have public health relevance and emphasize the need for more data on lithium concentrations in drinking water, including bottled water.
BACKGROUND:Lithium, used for treating bipolar disease, crosses freely the placenta and is classified as teratogenic. It is unclear to what extent environmental lithium exposure may affect fetal growth and development. OBJECTIVES: To elucidate potential effects of lithium exposure through drinking water during pregnancy on fetal size. METHODS: We developed a prospective population-based mother-child cohort (N=194) in an area with highly varying drinking waterlithium concentrations (5-1600 μg/L) in northern Argentinean Andes. Blood and urinary lithium concentrations (sampled repeatedly during pregnancy) were measured using inductively coupled plasma mass spectrometry. We measured fetal size by ultrasound in second and third trimesters, and weight, length and head circumference at birth. Multivariable models were used to examine associations between lithium exposure (continuous and in tertiles) and fetal size measures. RESULTS:Lithium in maternal blood (median 25; range 1.9-145 μg/L) and urine (1645; 105-4600 μg/L) was inversely associated (apparently linearly) with all fetal measures (body, head and femur) in the second trimester, and with birth length (β -0.53 cm per 25 μg/L increase in blood lithium, 95%CI -1.0; -0.052). An increase of 100 μg/L in blood was associated with 2 cm shorter newborns (about one standard deviation). CONCLUSIONS:Lithium exposure through drinking water was associated with impaired fetal size and this seemed to be initiated in early gestation. Further studies are warranted to confirm causality and to understand the mechanisms. If confirmed, these findings have public health relevance and emphasize the need for more data on lithium concentrations in drinking water, including bottled water.
Authors: Daniel König; Josef Baumgartner; Victor Blüml; Andrés Heerlein; Carlos Téllez; Nicole Baus; Nestor D Kapusta Journal: Neuropsychiatr Date: 2017-03-29
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Authors: Eline Mp Poels; Karin Sterrenburg; André I Wierdsma; Richard Wesseloo; Annemerle Beerthuizen; Laura van Dijke; Condon Lau; Witte Jg Hoogendijk; Hanan El Marroun; Inge L van Kamp; Hilmar H Bijma; Veerle Bergink Journal: J Psychopharmacol Date: 2020-07-20 Impact factor: 4.153