Lithium and Pregnancy-I, Report From the Register of Lithium Babies

Abstract

We have collected information about 118 children born to mothers who were given lithium treatment during the first trimester of pregnancy. The data show that the risk of teratogenic effects is lower than one might have expected from some of the studies carried out on rats and mice; they do not answer the question of whether or not lithium is teratogenic in man. The data were collected retrospectively and therefore overestimate rather than underestimate the risk of teratogenicity. Introduction It has been known for many years that lithium (lithium salts, lithium ions) added to the medium surrounding eggs of sea urchins, snails, and other lower organisms may interfere with morphogenesis so that monsters are produced (Herbst, 1893; Schou, 1957). Teratogenic lithium effects have also been shown in mammals. Szabo (1970) administered lithium by gavage to pregnant mice and induced cleft palate in up to 30% of the young. Wright et al. (1971) gave lithium intra-peritoneally to pregnant rats and found cleft palate in 39% of the young, external ear defects in 45%, and eye defects in 63%. Other studies with the same and different animal species (rabbits, monkeys) and with administration of comparable lithium doses in the drinking fluid, in the diet, intraperitoneally, or sub-cutaneously have failed to show teratogenic action of lithium

Managing Bipolar Disorder during Pregnancy: Weighing the Risks and Benefits

“…More recent, controlled epidemiologic studies suggest a real, but more modest, teratogenic risk of Ebstein's anomaly following first-trimester lithium exposure (11,62,(65)(66)(67)(68)(69)(70) exposure to be between 1/1000 (0.1%) and 1/2000 (0.05%) births (11). Based on relatively well-designed studies, rates of other congenital cardiovascular defects among lithiumexposed infants have varied from 0.9% to 12% (11,67,69).…”

“…Although the estimated risk of Ebstein's anomaly in lithiumexposed infants is 10 to 20 times higher than in the general population, the absolute risk is small (0.05% to 0.1%), and lithium arguably remains the safest mood stabilizer for use during pregnancy. Nevertheless, the FDA fetal risk rating for lithium is D. Prenatal screening with a high-resolution ultrasound and fetal echocardiography is recommended at or about weeks 16 to 18 of gestation to screen for cardiac anomalies (11,62,65,70).…”

Lithium Use in Pregnancy and the Risk of Cardiac Malformations

“…1 Results from this registry-based study were interpreted as supporting a risk of Ebstein's anomaly that was increased by a factor of 400 among infants exposed in utero to lithium, 3 despite substantial methodologic limitations, including the lack of a control group and a possible over-representation of cases owing to retrospective enrollment. 4 Since then, anecdotal reports [10][11][12][13][14] and small studies have been published with inconclusive results (Table S1 in …”

Psychotropic Medications in Pregnancy and the Postpartum Period

“…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. 49,51 Lithium therapy is not contraindicated during pregnancy. The risk of maternal instability after abrupt discontinuation of therapy compared with the risk of adverse fetal effects is a main reason to maintain lithium therapy in such patients.…”