Lithium Use During Pregnancy Linked to Infant, Maternal Health Risks

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Lithium use is associated with teratogenicity, increasing neonatal morbidity risks.
Lithium use is associated with teratogenicity, increasing neonatal morbidity risks.

Treating mood disorders with lithium in the first trimester of pregnancy may increase infant malformation risks, according to a study published in Lancet.

An international team of investigators conducted a meta-analysis to determine the impact of lithium-containing mood disorder treatments on prenatal development and neonatal morbidities.

Using 6 international community and clinic groups, primary data were collected and analyzed for pregnant women and their offspring. Eligibility criteria included availability of health-related information; live-born singleton delivery (from 1997 to 2015); and maternal bipolar or major depressive disorder, or treatment with lithium during pregnancy. Women who were prescribed known teratogenic drugs during pregnancy were excluded from the study.

Primary outcomes included complications during pregnancy, delivery outcomes, neonatal hospital readmission within 28 days of birth, and congenital malformations. 

Of the 22,124 pregnancies, 727 were included in the lithium-exposed cohort, which was not linked to any prespecified pregnancy or delivery complications. The researchers reported an increase in neonatal hospital readmission within 28 days of birth in the lithium-exposed cohort compared with the control group (pooled prevalence, 27.5% vs 14.3%; pooled adjusted odds ratio [aOR], 1.62).

In addition, results suggested an increased risk for major malformation with lithium exposure within the first trimester compared with no exposure (pooled prevalence, 7.4% vs 4.3%; pooled aOR, 1.71).

No significant differences were reported for major cardiac malformations between lithium exposed and unexposed infants (pooled prevalence, 2.1% vs 1.6%; pooled aOR, 1.54).

“Considering both the effect sizes and the precision of the estimates in this meta-analysis, treatment decisions for pregnant women with mood disorders must weigh the potential for increased risks of lithium during pregnancy — in particular those associated with use of lithium during the first trimester — against its effectiveness at reducing relapse,” the authors concluded.

Reference

Munk-Olsen T, Liu X, Viktorin A, et al. Maternal and infant outcomes associated with lithium use in pregnancy: an international collaborative meta-analysis of six cohort studies [published online June 18, 2018]. Lancet. doi: 10.1016/S2215-0366(18)30180-9

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