Journal article
Lithium during pregnancy and after delivery: A review
International Journal of Bipolar Disorders, Vol.6, Article number: 26
2018
Abstract
Lithium is an effective treatment in pregnancy and postpartum for the prevention of relapse in bipolar disorder. However, lithium has also been associated with risks during pregnancy for both the mother and the unborn child. Recent large studies have confirmed the association between first trimester lithium exposure and an increased risk of congenital malformations. Importantly, the risk estimates from these studies are lower than previously reported. Tapering of lithium during the first trimester could be considered but should be weighed against the risks of relapse. There seems to be no association between lithium use and pregnancy or delivery related outcomes, but more research is needed to be more conclusive. When lithium is prescribed during pregnancy, lithium blood levels should be monitored more frequently than outside of pregnancy and preferably weekly in the third trimester. We recommend a high-resolution ultrasound with fetal anomaly scanning at 20 weeks. Ideally, delivery should take place in a specialised hospital where psychiatric and obstetric care for the mother is provided and neonatal evaluation and monitoring of the child can take place immediately after birth. When lithium is discontinued during pregnancy, lithium could be restarted immediately after delivery as strategy for relapse prevention postpartum. Given the very high risk of relapse in the postpartum period, a high target therapeutic lithium level is recommended. Most clinical guidelines discourage breastfeeding in women treated with lithium. It is highly important that clinicians inform and advise women about the risks and benefits of remaining on lithium in pregnancy, if possible preconceptionally. In this narrative review we provide an up-to-date overview of the literature on lithium use during pregnancy and after delivery leading to clinical recommendations.
Details
- Title
- Lithium during pregnancy and after delivery: A review
- Authors/Creators
- E.M.P. Poels (Author/Creator) - Erasmus University RotterdamH.H. Bijma (Author/Creator) - Erasmus MCM. Galbally (Author/Creator) - Murdoch UniversityV. Bergink (Author/Creator) - Erasmus University Rotterdam
- Publication Details
- International Journal of Bipolar Disorders, Vol.6, Article number: 26
- Publisher
- Springer Nature
- Identifiers
- 991005543135107891
- Copyright
- © The Author(s) 2018
- Murdoch Affiliation
- School of Psychology and Exercise Science
- Language
- English
- Resource Type
- Journal article
UN Sustainable Development Goals (SDGs)
This output has contributed to the advancement of the following goals:
Source: InCites
Metrics
86 File views/ downloads
69 Record Views
InCites Highlights
These are selected metrics from InCites Benchmarking & Analytics tool, related to this output
- Collaboration types
- Domestic collaboration
- International collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.72 Obstetrics & Gynecology
- 1.72.1072 Perinatal Mental Health
- Web Of Science research areas
- Psychiatry
- ESI research areas
- Clinical Medicine