Home Women Health More Data on Pregnancy Outcomes Related to Lithium Use During Pregnancy

More Data on Pregnancy Outcomes Related to Lithium Use During Pregnancy

More Data on Pregnancy Outcomes Related to Lithium Use During Pregnancy

For girls taking lithium for the treatment of bipolar disorder, selecting whether to take care of or discontinue lithium while pregnant is difficult. It is a process which requires careful and thoughtful consideration, weighing the danger of opposed outcomes related to exposure to lithium against the risk of recurrent illness within the setting of medication discontinuation. While we now have considerable information regarding the teratogenicity of lithium, we now have much less data regarding other pregnancy and neonatal outcomes.  

Analyzing data from five linked Swedish national registers, Hastie and colleagues investigated the associations between lithium use while pregnant and opposed pregnancy and neonatal outcomes.

Of the 854,017 women included on this evaluation, 434 (0.05%) used lithium while pregnant.  In comparison with non-exposed controls, women using lithium while pregnant had an increased risk of preterm birth (8.7% vs 3.0%; adjusted relative risk [aRR] 2.64; 95% CI 1.82-3.82) and huge for gestational age infants (9.0% vs 3.5%; aRR 2.64, 95% CI 1.91-3.66). There was no association between lithium exposure and risk of preeclampsia or birth of a small for gestational age infant. 

These associations were significant after restricting the evaluation to pregnant women with a diagnosed psychiatric illness (n=9552) and when comparing outcomes to a control group of girls treated with lithium who elected to discontinue lithium prior to pregnancy.

Inconsistent Results Across Studies

In the present study including 434 lithium-exposed pregnancies, lithium use while pregnant was related to an increased risk of preterm birth and the birth of a big for gestational age infant. There was no association between lithium exposure and preeclampsia or the birth of a small for gestational age infant.

Previous studies have raised concerns regarding the impact of lithium on pregnancy outcomes; nevertheless, it’s difficult to tell apart the results of the medication from the results of the underlying disorder. In a previous study analyzing data from the Medicaid Analytic eXtract and the outcomes of 874 lithium-exposed pregnancies, Cohen and colleagues were in a position to control for a wider range of potential confounders. After adjusting for these potential confounders, they found no association between lithium exposure and risk of several different negative pregnancy outcomes: preeclampsia, placental abruption, growth restriction and preterm birth.

In one other study, Boden and colleagues analyzed pregnancy outcomes in women with bipolar disorder and concluded that bipolar disorder in women, whether treated with medication or not, was related to worse pregnancy outcomes. The study suggests that while exposure to mood stabilizers while pregnant may carry some risk, this exposure to medication will not be the only reason for opposed pregnancy outcomes in women with bipolar disorder, and it is vital to notice that the illness itself– or behaviors related to having the illness– can also have a negative effect on pregnancy outcomes.

It’s Complicated

When counseling women with bipolar disorder who’re pregnant or planning to conceive, we must deal with optimizing treatment while pregnant, acknowledging that the avoidance of all medications will not be necessarily the safest option. Women planning a pregnancy have to be properly counseled regarding the risks of treatment versus the risks related to the untreated psychiatric illness within the mother, and the lady’s health care provider plays a crucial role in weighing these individual risks and choosing the perfect options for treatment.

Lithium will not be widely used; nevertheless, for a subset of girls, it’s a well-tolerated and efficacious treatment. For these women, there will not be effective alternatives. There may be a well-documented increase in the danger of cardiac malformations related to first trimester exposure to lithium. Based on the present available data, we must entertain the chance that lithium is related to certain opposed outcomes, including risk of preterm birth and huge for gestational age; nevertheless, the findings are inconsistent. These potential risks have to be balanced against the essential advantage of treatment and must be used to guide shared decision-making.

Ruta Nonacs, MD, PhD

Hastie R, Tong S, Hiscock R, et al. Maternal lithium use and the danger of opposed pregnancy and neonatal outcomes: a Swedish population-based cohort study. BMC Med. 2021; 19(1):291.


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