Lithium exposure during pregnancy: outcomes for women who attended a specialist antenatal clinic

Abstract

Introduction: Lithium treatment in pregnancy represents a significant dilemma for women and treating health professionals alike. The complexity of risk-benefit analysis is impacted by limited information.

Methods: A cohort study of 33 women with severe mental illness, who were prescribed lithium at any time during the pregnancy, and gave birth between December 2007 and January 2015 at a specialist antenatal clinic in Western Australia. A descriptive comparison for women who continued lithium throughout pregnancy, and those who ceased on discovery of pregnancy was undertaken examining demographic, obstetric, neonatal and psychiatric variables.

Results: Women who were prescribed lithium, irrespective of whether they continued or discontinued the medication represented a high risk group obstetrically, with high rates of smoking overall (33%) medical comorbidities (54%) and antenatal complications (88%). Preconception counseling occurred in 33% of the cohort but increased the likelihood of continuing lithium in pregnancy (p = .007). Compared to those who ceased lithium, women who remained on lithium through the pregnancy had increased rates of fetal ultrasound abnormalities such as abdominal circumference >90th % (p = .005). Psychiatric relapses through the antenatal and immediate postpartum period appeared to be due to a combination of factors.

Discussion: Pregnant women with severe mood disorders treated with lithium are a vulnerable, high-risk obstetric population who would benefit from preconception counseling, regular antenatal care in a tertiary center, delivery with neonatal pediatric support and experienced psychiatric management.

Keywords:

• Lithium
• mood disorders
• pregnancy
• obstetric
• neonatal outcomes

Disclosure statement

The authors declare that there is no conflict of interest.

Current knowledge on the subject

• Lithium use is recommended for the management of women with severe mood disorders.

• Lithium use in pregnancy is complex for both psychiatrist and obstetrician.

• Evidence-based knowledge is lacking due to the low number of patients who remain on lithium in pregnancy.

What this study adds

• Highlights the importance of preconception counseling for medication adherence in pregnancy if lithium is recommended.

• Abnormalities of ultrasound findings/effects on fetal growth in the third trimester of pregnancy warrant monitoring.

• Highlights the risk in switching from lithium to another psychotropic in the immediate postpartum period in order to breastfeed.