Lithium in Pregnant Women with Bipolar Disorder

Lithium is a highly effective mood stabilizer in the treatment of bipolar disorder and treatment-resistant unipolar depression. A systematic review and meta-analysis published in January 2020 in the American Journal of Psychiatry studied its safety and efficacy during pregnancy and the postpartum period, and it found the following:

The use of lithium has been associated with a higher likelihood of congenital abnormalities, with a prevalence of 4.1%, and heart abnormalities, with a prevalence of 1.2%.

This meta-analysis, published in January 2020, included 29 studies of pregnant women with bipolar disorder and concluded that the use of lithium was more effective in preventing relapses in the postpartum period than not using lithium. It also concluded that mothers with lithium doses below 600 mg per day had more responsive newborns and no increased risk of heart malformations.

In conclusion, this study determines that there is a risk associated with lithium exposure at any time during pregnancy, but it is low, and it increases with higher doses administered, especially in the first trimester of pregnancy (known as the embryogenesis period).

Ideally, women with bipolar disorder who wish to become mothers should plan their pregnancy during a symptom-free period (euthymia), and lithium should be prescribed at the minimum effective dose, with doses reduced as much as possible, especially during the first trimester and in the days leading up to delivery. The treatment should be individualized in each case to balance the drug’s safety and efficacy.