Maternal and infant outcomes associated with lithium use in pregnancy: an international collaborative meta-analysis of six cohort studies

Abstract

None.

Lithium Exposure During Pregnancy and the Postpartum Period: A Systematic Review and Meta-Analysis of Safety and Efficacy Outcomes

“…This discrepancy could be due to the inclusion of larger samples in our analysis, especially those provided by Patorno et al (11). In this sense, we acknowledge that some outcomes pooled in the present analyses should be considered preliminary, especially in the context of few Diav-Citrin 2Forsberg 27Forsberg 27Jacobson 26Munk-Olsen (Canada) (8) Munk-Olsen (Denmark) (8) Munk-Olsen (Sweden) 8Munk-Olsen (Netherlands) (8) Munk-Olsen (USA) (8) Munk-Olsen (UK) 8Frayne 28Troyer (29 comparisons and high between-and within-study heterogeneity as well as our inability to systematically stratify for study design. It is worth noting, however, that while we were able to expand the sample size and strengthen the statistical power of our analysis, the previous study by Munk-Olsen et al (8) also documented the rate of neonatal readmission within 28 days of birth, which was seen to be increased in the lithiumexposed group compared with the unexposed mood disorder group.…”

“…Consistent with the timing of organogenesis, the risk of cardiac anomalies was significantly higher in children of lithium-exposed than unexposed patients with bipolar disorder during the first trimester of pregnancy, but not in those of mothers exposed at any time of pregnancy. In contrast, the meta-analysis by Munk-Olsen et al (8) documented a statistically significant increased risk for major malformations during the first trimester of pregnancy, but not for major cardiac malformations. This discrepancy could be due to the inclusion of larger samples in our analysis, especially those provided by Patorno et al (11).…”

“…According to a recent meta-analysis assessing maternal and infant outcomes associated with lithium use during pregnancy from six international cohorts (8), lithium exposure during the first trimester was associated with a relative 171% increase in the odds of a major malformation (an absolute risk of 7.4% with lithium, compared with 4.3% in offspring not exposed to lithium), and a 162% increase in the odds of neonatal readmission rates within 4 weeks of birth compared with an unexposed mood disorder reference group (an absolute risk of 27.5% in offspring exposed to lithium, compared with 14.3% in offspring not exposed). In contrast, the odds for major malformations in exposed offspring, especially neural tube defects and Ebstein's anomaly (downward displacement of the tricuspid valve into the right ventricle and variable levels of right ventricle hypoplasia) did not significantly differ from those in unexposed offspring (8). Aside from lithium teratogenicity, neonatal toxicity events may occur in offspring exposed to lithium during labor, including the so-called floppy baby syndrome (characterized by cyanosis and hypotonicity), neonatal hypothyroidism, and nephrogenic diabetes insipidus (9).…”

Schizophrenia around the time of pregnancy: leveraging population-based health data and electronic health record data to fill knowledge gaps

“…Use of these routinely collected health data also requires knowledge and expertise in different areas including medicine and health services, medical sciences, information technology infrastructure and data analytics, particularly as access to increased variety of data sources is increasing. In line with this, we have already published a multicentre meta-analysis using data from six countries including Canada, Denmark and the UK, looking at exposure to lithium in pregnancy, 66 finding increased risk of neonatal admissions within 28 days of birth and increased risk of major malformations but not cardiac malformation, which has been traditionally associated with lithium use in pregnancy. This study has documented both feasibility and relevance of pooling these data sources internationally.…”

Methods and considerations concerning cardiac output measurement in pregnant women: recommendations of the International Working Group on Maternal Hemodynamics

“…The amounts of lithium used to calibrate LiDCOplus are very low, especially when compared with standard therapeutic doses in pregnant women with bipolar disorders; however, lithium can cross the placenta freely. Two recent meta‐analyses addressed the long‐term neurodevelopment outcomes in offspring with in‐utero exposure to lithium. While preclinical data in animals suggest a potential adverse effect, clinical data in humans, although limited to 97 children, seem reassuring.…”