For girls taking lithium for the remedy of bipolar dysfunction, selecting whether or not to take care of or discontinue lithium throughout being pregnant is difficult. It is a course of which requires cautious and considerate consideration, weighing the chance of hostile outcomes related to publicity to lithium towards the danger of recurrent sickness within the setting of treatment discontinuation. Whereas we’ve appreciable data concerning the teratogenicity of lithium, we’ve a lot much less information concerning different being pregnant and neonatal outcomes.
Analyzing information 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 start (8.7% vs 3.0%; adjusted relative danger [aRR] 2.64; 95% CI 1.82-3.82) and enormous 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 start of a small for gestational age toddler.
These associations had been important after proscribing the evaluation to pregnant ladies with a identified psychiatric sickness (n=9552) and when evaluating outcomes to a management group of ladies 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 start and the start of a giant for gestational age toddler. There was no affiliation between lithium publicity and preeclampsia or the start of a small for gestational age toddler.
Earlier research have raised issues concerning the affect of lithium on being pregnant outcomes; nonetheless, it’s tough to differentiate the consequences of the treatment from the consequences of the underlying dysfunction. In a earlier examine analyzing information from the Medicaid Analytic eXtract and the outcomes of 874 lithium-exposed pregnancies, Cohen and colleagues had 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 totally different unfavourable being pregnant outcomes: preeclampsia, placental abruption, progress restriction and preterm start.
In one other examine, Boden and colleagues analyzed being pregnant outcomes in ladies with bipolar dysfunction and concluded that bipolar dysfunction in ladies, whether or not handled with treatment 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 treatment just isn’t the only motive for hostile being pregnant outcomes in ladies with bipolar dysfunction, and it is very important be aware that the sickness itself– or behaviors related to having the sickness– may additionally have a unfavourable impact on being pregnant outcomes.
When counseling ladies with bipolar dysfunction who’re pregnant or planning to conceive, we should give attention to optimizing remedy throughout being pregnant, acknowledging that the avoidance of all drugs just isn’t essentially the most secure possibility. Girls planning a being pregnant should be correctly endorsed concerning the dangers of remedy versus the dangers related to the untreated psychiatric sickness within the mom, and the lady’s well being care supplier performs an vital function in weighing these particular person dangers and selecting the right choices for remedy.
Lithium just isn’t extensively used; nonetheless, for a subset of ladies, it’s a well-tolerated and efficacious remedy. For these ladies, there is probably not efficient 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 accessible information, we should entertain the likelihood that lithium is related to sure hostile outcomes, together with danger of preterm start and enormous for gestational age; nonetheless, the findings are inconsistent. These potential dangers should be balanced towards the vital good thing about remedy and must be used to information shared decision-making.
Ruta Nonacs, MD, PhD
Hastie R, Tong S, Hiscock R, et al. Maternal lithium use and the chance of hostile being pregnant and neonatal outcomes: a Swedish population-based cohort examine. BMC Med. 2021; 19(1):291.