Lithium is a staple and highly effective medication for the treatment of bipolar disorder; however, past data have indicated somewhat mixed data regarding the teratogenic effects of lithium use during pregnancy. In this large meta-analysis, using data from six different countries, the authors investigated the effects of lithium use during pregnancy on several maternal and infant outcomes. Comparing women with mood disorders who either used lithium during pregnancy (lithium group) and women who did not use lithium (reference group) the authors found clear indications of increased risk for major malformations (but not major cardiac malformations) when women had used lithium during the first trimester (Figure). Although numerous measures of pregnancy complications and labor and delivery outcomes were unaffected by lithium use during pregnancy, there was an increased risk of neonatal hospital readmission within the first 28 days postpartum. The authors suggest that this increased hospital readmission may be due to lithium withdrawal in the infant, lithium exposure during lactation, and/or increased vigilance toward neonatal lithium effects. These data help to clarify some of the previously conflicting data found with regards to lithium use during pregnancy and will assist clinicians and patients in balancing the risks associated with peripartum lithium use vs. the risks of untreated maternal mood disorders.

Reference:

Munk-olsen T, Liu X, Viktorin A, et al. Maternal and infant outcomes associated with lithium use in pregnancy: an international collaborative meta-analysis of six cohort studies. Lancet Psychiatry. 2018; Epub ahead of print. Abstract

To learn more about managing mood disorders during pregnancy, NEI Member can access:

CNS Spectrums Article: Between a Rock-a-bye and a Hard Place: Mood Disorders During the Peripartum Period

Congress Encore: Between a Rock-a-bye and a Hard Place: Mood Disorders During the Peripartum Period