For girls taking lithium for the therapy of bipolar dysfunction, choosing whether to maintain or discontinue lithium during pregnancy is challenging. This can be a course of which requires cautious and considerate consideration, weighing the danger of hostile outcomes related to publicity to lithium in opposition to the risk of recurrent illness in the setting of medication discontinuation. Whereas we’ve appreciable info relating to the teratogenicity of lithium, we’ve a lot much less knowledge relating to different being pregnant and neonatal outcomes.
Analyzing knowledge from 5 linked Swedish nationwide registers, Hastie and colleagues investigated the associations between lithium use throughout being pregnant and hostile being pregnant and neonatal outcomes.
Of the 854,017 ladies included on this evaluation, 434 (0.05%) used lithium throughout being pregnant. In comparison with non-exposed controls, ladies utilizing lithium throughout being pregnant had an elevated danger of preterm delivery (8.7% vs 3.0%; adjusted relative danger [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 affiliation between lithium publicity and danger of preeclampsia or delivery of a small for gestational age toddler.
These associations have been vital after limiting the evaluation to pregnant ladies with a identified psychiatric sickness (n=9552) and when evaluating outcomes to a management group of girls handled with lithium who elected to discontinue lithium previous to being pregnant.
Inconsistent Outcomes Throughout Research
Within the present examine together with 434 lithium-exposed pregnancies, lithium use throughout being pregnant was related to an elevated danger of preterm delivery and the delivery of a giant for gestational age toddler. There was no affiliation between lithium publicity and preeclampsia or the delivery of a small for gestational age toddler.
Previous studies have raised concerns regarding the impact of lithium on pregnancy outcomes; nonetheless, it’s troublesome to tell apart the consequences of the medicine from the consequences of the underlying dysfunction. In a earlier examine analyzing data from the Medicaid Analytic eXtract and the outcomes of 874 lithium-exposed pregnancies, Cohen and colleagues have been in a position to management for a wider vary of potential confounders. After adjusting for these potential confounders, they discovered no affiliation between lithium publicity and danger of a number of completely different detrimental being pregnant outcomes: preeclampsia, placental abruption, development restriction and preterm delivery.
In one other examine, Boden and colleagues analyzed pregnancy outcomes in women with bipolar disorder and concluded that bipolar dysfunction in ladies, whether or not handled with medicine or not, was related to worse being pregnant outcomes. The examine means that whereas publicity to temper stabilizers throughout being pregnant could carry some danger, this publicity to medicine is just not the only real motive for hostile being pregnant outcomes in ladies with bipolar dysfunction, and you will need to word that the sickness itself– or behaviors related to having the sickness– can also have a detrimental impact on being pregnant outcomes.
It’s Sophisticated
When counseling ladies with bipolar dysfunction who’re pregnant or planning to conceive, we should concentrate on optimizing therapy throughout being pregnant, acknowledging that the avoidance of all drugs is just not essentially the most secure possibility. Ladies planning a being pregnant have to be correctly recommended relating to the dangers of therapy versus the dangers related to the untreated psychiatric sickness within the mom, and the girl’s well being care supplier performs an necessary function in weighing these particular person dangers and choosing the right choices for therapy.
Lithium is just not broadly used; nonetheless, for a subset of girls, it’s a well-tolerated and efficacious therapy. For these ladies, there is probably not efficient alternate options. There’s a well-documented enhance within the danger of cardiac malformations related to first trimester publicity to lithium. Primarily based on the present out there knowledge, we should entertain the likelihood that lithium is related to sure hostile outcomes, together with danger of preterm delivery and huge for gestational age; nonetheless, the findings are inconsistent. These potential dangers have to be balanced in opposition to the necessary advantage of therapy and ought to be used to information shared decision-making.
Ruta Nonacs, MD, PhD
Hastie R, Tong S, Hiscock R, et al. Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study. BMC Med. 2021; 19(1):291.
