Pregnancy Outcome Following In Utero Exposure to Lithium: A Prospective, Comparative, Observational Study

Diav–Citrin, Orna; Shechtman, Svetlana; Tahover, Esther; Finkel-Pekarsky, Victoriya; Arnon, Judy; Kennedy, Debra; Erebara, Aida; Einarson, Adrienne; Ornoy, Asher

doi:10.1176/appi.ajp.2014.12111402

Cited by 131 publications

(90 citation statements)

References 32 publications

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“…Another study on adverse birth outcome following lithium exposure in pregnancy identified 83 lithium-exposed pregnancies among women who contacted the Israeli Teratology Information Service between 1999 and 2010. 51 Both studies support our findings that lithium is still used by pregnant women, but rarely.…”

Section: Psychotropic Medication Prescribed Before During and After supporting

confidence: 83%

“…93 The Swedish study discussed previously 48 included 79 women using lithium in pregnancy and identified four children with congenital cardiac malformations equivalent to a prevalence rate of 5.1% (95% CI 1.4% to 12.5%). A recent study 51 based on 183 women exposed to lithium during pregnancy who contacted the Israeli Teratology Information Service also suggests lithium treatment in pregnancy is associated with a higher rate of cardiovascular anomalies. We had only 28 mother-child pairs in our study in which the mother had been prescribed lithium in pregnancy and were therefore unable to conduct further analysis on congenital malformations.…”

Section: Lithiummentioning

confidence: 99%

See 1 more Smart Citation

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Petersen

McCrea

Sammon

et al. 2016

Health Technol Assess

133

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BackgroundAlthough many women treated with psychotropic medication become pregnant, no psychotropic medication has been licensed for use in pregnancy. This leaves women and their health-care professionals in a treatment dilemma, as they need to balance the health of the woman with that of the unborn child. The aim of this project was to investigate the risks and benefits of psychotropic medication in women treated for psychosis who become pregnant.Objective(s)(1) To provide a descriptive account of psychotropic medication prescribed before pregnancy, during pregnancy and up to 15 months after delivery in UK primary care from 1995 to 2012; (2) to identify risk factors predictive of discontinuation and restarting of lithium (multiple manufacturers), anticonvulsant mood stabilisers and antipsychotic medication; (3) to examine the extent to which pregnancy is a determinant for discontinuation of psychotropic medication; (4) to examine prevalence of records suggestive of adverse mental health, deterioration or relapse 18 months before and during pregnancy, and up to 15 months after delivery; and (5) to estimate absolute and relative risks of adverse maternal and child outcomes of psychotropic treatment in pregnancy.DesignRetrospective cohort studies.SettingPrimary care.ParticipantsWomen treated for psychosis who became pregnant, and their children.InterventionsTreatment with antipsychotics, lithium or anticonvulsant mood stabilisers.Main outcome measuresDiscontinuation and restarting of treatment; worsening of mental health; acute pre-eclampsia/gestational hypertension; gestational diabetes; caesarean section; perinatal death; major congenital malformations; poor birth outcome (low birthweight, preterm birth, small for gestational age, low Apgar score); transient poor birth outcomes (tremor, agitation, breathing and muscle tone problems); and neurodevelopmental and behavioural disorders.Data sourcesClinical Practice Research Datalink database and The Health Improvement Network primary care database.ResultsPrescribing of psychotropic medication was relatively constant before pregnancy, decreased sharply in early pregnancy and peaked after delivery. Antipsychotic and anticonvulsant treatment increased over the study period. The recording of markers of worsening mental health peaked after delivery. Pregnancy was a strong determinant for discontinuation of psychotropic medication. However, between 40% and 76% of women who discontinued psychotropic medication before or in early pregnancy restarted treatment by 15 months after delivery. The risk of major congenital malformations, and neurodevelopmental and behavioural outcomes in valproate (multiple manufacturers) users was twice that in users of other anticonvulsants. The risks of adverse maternal and child outcomes in women who continued antipsychotic use in pregnancy were not greater than in those who discontinued treatment before pregnancy.LimitationsA few women would have received parts of their care outside primary care, which may not be captured in this analysis. Likewise, the analyses were based on prescribing data, which may differ from usage.ConclusionsPsychotropic medication is prescribed before, during and after pregnancy. Many women discontinue treatment before or during early pregnancy and then restart again in late pregnancy or after delivery. Our results support previous associations between valproate and adverse child outcomes but we found no evidence of such an association for antipsychotics.Future workFuture research should focus on (1) curtailing the use of sodium valproate; (2) estimating the benefits of psychotropic drug use in pregnancy; and (3) investigating the risks associated with lifestyle choices that are more prevalent among women using psychotropic drugs.Funding detailsThe National Institute for Health Research Health Technology Assessment programme.

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Section: Psychotropic Medication Prescribed Before During and After supporting

confidence: 83%

Section: Lithiummentioning

confidence: 99%

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Petersen

McCrea

Sammon

et al. 2016

Health Technol Assess

133

View full text Add to dashboard Cite

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“…50,51 An often reported significant effect of lithium therapy is birth of large for gestational age (LGA) infants, with affected babies weighing an average of ∼100 gm heavier than their nonexposed counterparts. 51,52 Neonatal hypotonicity or "floppy baby" syndrome is also a noted adverse outcome of neonatal lithium toxicity, often resolving completely after the drug clearance. 9,40 There are no data that support or describe any detrimental long-term behavioral or developmental effects on neonates of mothers treated with lithium.…”

Section: No Medical Treatmentmentioning

confidence: 99%

“…40 If a woman continues Lithium therapy during conception and pregnancy, it is recommended that she undergo a fetal echocardiography in addition to her routine anatomy ultrasound. 52 In a well-controlled BPD patient in whom expectant management is appropriate, either medication tapering or drug discontinuation during the first trimester is a reasonable choice. Lithium is excreted into breast milk, and the infant serum levels are near therapeutic levels.…”

Section: No Medical Treatmentmentioning

confidence: 99%

Psychotropic Medications in Pregnancy and the Postpartum Period

Haas

McHugh

Durst

et al. 2015

Clinical Medicine Insights: Therapeutics

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Many pregnant women suffer from mental health conditions while pregnant. As providers and patients make decisions about risks of the conditions and treatments during pregnancy, information to populate those discussions is needed. Taking into account the physiologic changes in pregnancy, we may need to optimize medication therapy. This article reviews and summarizes some of the most common mental health conditions suffered in pregnancy: depression, bipolar disorder, anxiety, and psychosis. It further discusses the different medications used to treat them, as well as risks associated with these medications.

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“…21 In two uncontrolled cohort studies of lithium-exposed pregnancies, no cardiac malformations were detected in the 82 newborns examined 22,23 ; another uncontrolled study showed four mild cardiac defects in 79 exposed infants. 24 Four controlled cohort studies (involving between 59 and 138 lithiumexposed pregnancies) [25][26][27][28] showed conflicting results. Therefore, women with bipolar disorder who are of childbearing age and are planning to become pregnant have to balance the risks and benefits of treatment continuation on the basis of limited and conflicting evidence regarding the safety of lithium for the developing fetus.…”

mentioning

confidence: 99%

Lithium Use in Pregnancy and the Risk of Cardiac Malformations

Patorno

Huybrechts

Bateman

et al. 2017

Obstetric Anesthesia Digest

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Pregnancy Outcome Following In Utero Exposure to Lithium: A Prospective, Comparative, Observational Study

Abstract: Lithium treatment in pregnancy is associated with a higher rate of cardiovascular anomalies. Women who are treated with lithium during organogenesis should undergo fetal echocardiography and level-2 ultrasound.

Cited by 131 publications

References 32 publications

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Psychotropic Medications in Pregnancy and the Postpartum Period

Lithium Use in Pregnancy and the Risk of Cardiac Malformations

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