For ladies taking lithium for the remedy of bipolar dysfunction, selecting whether or not to keep up or discontinue lithium throughout being pregnant is difficult. This can be a course of which requires cautious and considerate consideration, weighing the chance of hostile outcomes related to publicity to lithium in opposition to the threat of recurrent sickness within the setting of medicine discontinuation. Whereas we’ve appreciable data concerning the teratogenicity of lithium, we’ve a lot much less knowledge concerning 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 threat of preterm delivery (8.7% vs 3.0%; adjusted relative threat [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 threat of preeclampsia or delivery of a small for gestational age toddler.
These associations had been vital 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 threat of preterm delivery and the delivery of a big for gestational age toddler. There was no affiliation between lithium publicity and preeclampsia or the delivery of a small for gestational age toddler.
Earlier research have raised considerations concerning the impression of lithium on being pregnant outcomes; nevertheless, it’s tough to differentiate the consequences of the medicine from the consequences of the underlying dysfunction. In a earlier examine analyzing knowledge from the Medicaid Analytic eXtract and the outcomes of 874 lithium-exposed pregnancies, Cohen and colleagues had been capable of management for a wider vary of potential confounders. After adjusting for these potential confounders, they discovered no affiliation between lithium publicity and threat of a number of completely different detrimental being pregnant outcomes: preeclampsia, placental abruption, progress restriction and preterm delivery.
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 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 threat, this publicity to medicine shouldn’t be the only real purpose 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– might 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 remedy throughout being pregnant, acknowledging that the avoidance of all medicines shouldn’t be essentially the most secure choice. 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 girl’s well being care supplier performs an necessary position in weighing these particular person dangers and choosing the right choices for remedy.
Lithium shouldn’t be extensively used; nevertheless, for a subset of ladies, it’s a well-tolerated and efficacious remedy. For these ladies, there might not be efficient alternate options. There’s a well-documented enhance within the threat of cardiac malformations related to first trimester publicity to lithium. Based mostly on the present out there knowledge, we should entertain the likelihood that lithium is related to sure hostile outcomes, together with threat of preterm delivery and enormous for gestational age; nevertheless, the findings are inconsistent. These potential dangers should be balanced in opposition to the necessary advantage of remedy and needs 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 chance of hostile being pregnant and neonatal outcomes: a Swedish population-based cohort examine. BMC Med. 2021; 19(1):291.
