The effect of prenatal lithium exposure on the neuropsychological development of the child

Abstract

Objectives Lithium is an effective treatment for bipolar disorder, also during pregnancy to prevent the recurrence of episodes in the perinatal period. Little is known about the neuropsychological development of lithium‐exposed offspring. The current study was designed to investigate neuropsychological functioning in lithium‐exposed children with the aim to provide further knowledge on the long‐term effects of lithium use during pregnancy. Methods Participants were offspring of women with a diagnosis of bipolar spectrum disorder, aged 6–14 years. In total, 99 children participated in the study, 56 were exposed to lithium in utero and 43 were not exposed to lithium. Neuropsychological tests were administered, including the Snijders‐Oomen Nonverbal Intelligence Test and the NEPSY‐II‐NL assessment. Linear and negative binomial regression models were used to investigate the association between prenatal lithium exposure and neuropsychological functioning. In secondary analyses, the association between lithium blood level during pregnancy and neuropsychological functioning was assessed. Additionally, norm scores and percentiles for task outcomes were calculated. Results Lithium use during pregnancy was associated with the total number of mistakes made on the Auditory Attention task, but not statistically significant after full adjustment for potential confounding factors. No association between prenatal lithium exposure and IQ was found. Also, no relationship between lithium blood level during pregnancy and neuropsychological functioning was found after adjustment for potential confounders. Task outcomes in both groups were comparable to the general population. Conclusion In this study, we found no evidence for significantly altered neuropsychological functioning of lithium‐exposed children at the age of 6–14 years, when compared to non‐lithium‐exposed controls.

Lithium use in childhood and adolescence, peripartum, and old age: an umbrella review

“…Available data were reassuring, although limited, and suggest that lithium use during pregnancy is associated with normal child neurodevelopment. This observation is in line with a very recent study founding no evidence for significantly altered neuropsychological functioning of lithium-exposed children at the age of 6–14 years (Poels et al 2022 ). Specifically, authors found no association between prenatal lithium exposure and IQ and no relationship between lithium blood level during pregnancy and neuropsychological functioning (Poels et al 2022 ).…”

Neurodevelopment in school‐aged children after intrauterine exposure to antipsychotics

“…A high number of generated words reflects good functioning. A detailed description of the selected subtests may be found in our previously published paper 21 . Presence of learning problems and/or psychiatric disorders was assessed by parental report, worded as follows: “Has your child been diagnosed with a psychiatric disorder?…”

“…The current investigation was part of a cohort study designed to investigate neurodevelopmental functioning of children of mothers with SMI who were exposed or unexposed to lithium or antipsychotic medication in utero. 21 Patients were recruited from three centers in the…”

Early Postnatal Outcome and Care after in Utero Exposure to Lithium: A Single Center Analysis of a Belgian Tertiary University Hospital

“…However, both studies had a retrospective design and a small cohort [ 24 , 53 ]. The prospective studies of Schou (1976) and Jacobson et al (1992) reported no differences in development between exposed children and controls [ 9 , 54 , 55 ], and very recently Poels et al (2022) found no evidence for significantly altered neuropsychological functioning of children (6–14 years) with previously in utero exposure to lithium [ 56 ]. Third, the data were retrospectively collected, which means they were dependent on the quality of the registration of data in medical records.…”