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Lithium during pregnancy: malformations, fetotoxicity and uncertain long-term effects

FEATURED REVIEW Outside the context of pregnancy, lithium is the standard "mood stabiliser" for the treatment of bipolar disorder. What are the main known short-term and long-term consequences of in utero exposure to lithium?
Full review (3 pages) available for download by subscribers.

Abstract

  • A meta-analysis of about 600 pregnant women exposed to lithium during the first trimester of pregnancy, from six cohorts, showed that lithium roughly doubled the risk of major malformations.
     
  • Another study in about 700 pregnant women with first-trimester exposure showed that doses of lithium above 600 mg per day increased the risk of congenital heart defects, in particular Ebstein's anomaly.
     
  • Second- and third-trimester exposure increases the risk of polyhydramnios. Seizures, hypotonia, and heart rate and heart rhythm disorders are foreseeable.

  • Various neonatal complications, in particular neurological and cardiac disorders, appear to increase when the mother's serum lithium concentration at delivery exceeds 0.67 mmol/l.
     
  • The long-term neuropsychiatric effects of in utero exposure are virtually unknown.
     
  • In practice, lithium's adverse effects on the unborn child are so serious that women who take lithium and could become pregnant should be informed of the risks, and certain precautions should be taken:
    • If a woman has no plans to start a pregnancy in the near future, it is prudent to advise her to use contraception.
    • She should also be warned that if she becomes pregnant, it is advisable to suspend lithium treatment from the start of pregnancy to the end of the 3rd month, and again close to delivery.
    • Between these two periods, it is important to monitor serum lithium levels to determine the minimum effective dose. 

©Prescrire 1 April 2020

Full review (3 pages) available for download by subscribers.

"Lithium during pregnancy: malformations, fetotoxicity and uncertain long-term effects" Prescrire Int 2020; 29 (214): 97-99 (Pdf, subscribers only).

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Download the full review.
Pdf, subscribers only

See also:

Lithium for bipolar disorder:
prevent adverse effects
(March 2014)
Free

Proper management
of lithium therapy
Prescrire Int 2011;
20 (122): 295-296.
Pdf, subscribers only