Chapter 5 106 studies. The retrospective cohort consisted of a convenience sample of neonates of singleton pregnant women, ≥18 years, with BD diagnosed by a psychiatrist before pregnancy, or clear symptoms of BD before pregnancy and confirmed diagnosis (by a psychiatrist) postpartum. Participants gave birth to a liveborn neonate between January 2011 and March 2021 at OLVG hospital (a large secondary care hospital in Amsterdam, the Netherlands), or had their child admitted directly postpartum after home delivery due to complications or as per protocol. In the Netherlands, obstetric care is divided between community midwifes (primary care), obstetriciangynaecologists (secondary care) and academic referral centres (tertiary care). When lithium was used at any point throughout the pregnancy, neonates were included in the lithium exposed group (including women who started lithium after the first trimester (n=3)), other neonates were included in the non-lithium exposed group. We excluded women with an uncertain diagnosis of BD, twin pregnancies, or records with missing information on maternal and neonatal outcomes. All records were hand searched by one researcher and discussed with a second or third researcher if necessary to prevent misclassification of outcomes. The Medical Research Involving Human Subjects Act was not applicable for this study. The study was approved by the Advisory Committee Scientific Research at OLVG hospital who granted exemption for written informed consent because of the large number of records to search. Study variables and definition of outcomes We primarily investigated the number of, and reasons for admissions to the neonatal ward with monitoring (level 2 care). In OLVG hospital, neonates born to women with BD are observed for minimally 24 h while roomed in with their mothers on the maternity ward (level 1 care, which has no opportunity for continuous monitoring of vital parameters) and only admitted to the neonatal ward with monitoring when indicated by the paediatrician. In other Dutch hospitals, admission to a neonatal ward with monitoring of vital parameters for at least 24–48 h is generally the norm. Data on all other adverse outcomes in neonates admitted within 28 days postpartum was collected from obstetric and neonatal patient files. Data on the mothers’ sociodemographic characteristics, medication use (including lithium dosage of pregnant women), and neonatal outcomes were extracted from patient files. Prematurity was defined as delivery before 37 weeks of gestation, large for gestational age as weight above the 97th percentile, small for gestational age under the 10th percentile16 and maternal obesity as a body mass index > 30 kg/m2.
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