Obstetric outcomes regarding the use of lithium in pregnant women with bipolar disorders: a prospective cohort study

Sagué-Vilavella, María; Solé, Eva; Pinzón‐Espinosa, Justo; Sandra-Hernández, Ana; Roda, E.; Vieta, Eduard; Roca, A.

doi:10.1007/s00737-022-01234-8

Cited by 10 publications

(8 citation statements)

References 34 publications

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“…Whether this atrial flutter was a result of lithium toxicity or a congenital condition, is unclear. With no significant risk of neonatal complications in lithium-exposed newborns, our study, except for their finding of lower Apgar scores, is in accordance with a recent cohort study (Sagué-Vilavella et al 2022 ). Obstetric vulnerability in our sample of women with BD was marked by higher levels of caesarean section (Seijmonsbergen-Schermers et al 2018 ), gestational diabetes (Horsselenberg et al 2021 ), and hypertensive disorders (Koopmans et al 2009 ).…”

Section: Discussionsupporting

confidence: 93%

“…Others described an association of BD with adverse obstetric and pregnancy outcomes such as increased risk of caesarean section, small- or large for gestational age neonates and preeclampsia (Vigod et al 2014 ; Rusner et al 2016 ). Moreover, previous research has reported an association between lithium and congenital malformations (Hastie et al 2021 ; Fornaro et al 2020 ; Patorno et al 2017 ), lower Apgar scores (Sagué-Vilavella et al 2022 ; Newport et al 2005 ) and neonatal readmission within 28 days postpartum (Munk-Olsen et al 2018 ). Although reasons for admission of lithium-exposed neonates were not available, the authors suggested that admissions were the result of increased vigilance towards neonates exposed to lithium, neonatal withdrawal syndrome and vulnerability of neonates due to impaired maternal mental health.…”

Section: Introductionmentioning

confidence: 97%

“…Previous research has yielded contradicting outcomes. Various cohort studies and systematic reviews (with meta-analyses) have found no increased risk in obstetric outcomes such as hypertensive disorders of pregnancy and gestational diabetes in women with BD with versus without lithium use (Poels et al 2018 ; Munk-Olsen et al 2018 ; Bodén et al 2012 ; Fornaro et al 2020 ; Sagué-Vilavella et al 2022 ). Yet, some studies have suggested a small increased risk of spontaneous abortion, preterm birth, and increased birthweight after maternal lithium use (Hastie et al 2021 ; Poels et al 2021 ).…”

Section: Introductionmentioning

confidence: 99%

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Neonatal admission after lithium use in pregnant women with bipolar disorders: a retrospective cohort study

Schonewille

Terpstra

Heuvel

et al. 2023

Int J Bipolar Disord

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Background Lithium is the preferred treatment for pregnant women with bipolar disorders (BD), as it is most effective in preventing postpartum relapse. Although it has been prescribed during pregnancy for decades, the safety for neonates and obstetric outcomes are a topic of ongoing scientific debate as previous research has yielded contradicting outcomes. Our study aims to compare (re)admission rates and reasons for admissions in neonates born to women with bipolar disorders (BD) with and without lithium exposure. Methods A retrospective observational cohort study was conducted in a Dutch secondary hospital (two locations in Amsterdam). Women with BD who gave birth after a singleton pregnancy between January 2011 and March 2021 and their neonates were included. Outcomes were obtained by medical chart review of mothers and neonates and compared between neonates with and without lithium exposure. The primary outcome was admission to a neonatal ward with monitoring, preterm birth, small for gestational age (SGA), 5-minute Apgar scores, neonatal asphyxia, and readmission ≤ 28 days. Results We included 93 women with BD, who gave birth to 117 live-born neonates: 42 (36%) exposed and 75 (64%) non-exposed to lithium. There were no significant differences in neonatal admission with monitoring (16.7 vs. 20.0%, p = 0.844). Additionally, preterm birth (7.1 vs. 5.3%), SGA (0.0 vs. 8.0%), 5-minute Apgar scores (means 9.50 vs. 9.51), neonatal asphyxia (4.8 vs. 2.7%) and readmission (4.8 vs. 5.3%) were comparable. Overall, 18.8% of BD offspring was admitted. Women with BD had high rates of caesarean section (29.1%), gestational diabetes (12.8%) and hypertensive disorders of pregnancy (8.5%). Conclusions In a sample of neonates all born to women with BD using various other psychotropic drugs, exposure to lithium was not associated with greater risk of neonatal admission to a ward with monitoring compared to non-exposure to lithium, questioning the necessity for special measures after lithium exposure. However, offspring of women with BD was admitted regularly and women with BD have high obstetric risk which require clinical and scientific attention.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Neonatal admission after lithium use in pregnant women with bipolar disorders: a retrospective cohort study

Schonewille

Terpstra

Heuvel

et al. 2023

Int J Bipolar Disord

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“…4 Another recent study found a link between lithium use and lower Apgar scores at 1 minute and 5 min, without identifying other obstetric or neonatal complications. 5 To our knowledge, only three case reports have been published that discuss severe polyhydramnios associated with lithium treatment. However, there have been no studies that assess the incidence of polyuria-polydipsia syndrome, of NDI or of polyhydramnios associated with lithium prescription during pregnancy, despite these being known side effects associated with chronic lithium use.…”

Section: Considering Temporarily Discontinuing Lithium Intakementioning

confidence: 99%

A case of pregnancy with severe polyhydramnios related to long‐term use of lithium

Stoppa,

Roda,

Garcia‐Esteve

et al. 2024

Bipolar Disorders

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ObjectivesSevere polyhydramnios during pregnancy may be associated with long‐term lithium use and presents considerable challenges. This complication, which has been linked to induced nephrogenic diabetes insipidus (NDI), underscores the necessity for cautious management of pregnant women with bipolar disorder. This case report aims to elucidate the relationship between long‐term lithium use, pregnancy, and the development of severe polyhydramnios, emphasizing the importance of diagnosing NDI in order to prevent obstetric and neonatal complications.MethodsWe present the case of a 42‐year‐old primigravida undergoing long‐term lithium treatment for bipolar disorder type I, who developed severe polyhydramnios at 34 weeks of gestation. Clinical data including obstetric monitoring and neonatal outcomes were analyzed.ResultsThis case emphasizes the need for heightened awareness and proactive measures to mitigate the risk associated with lithium treatment during pregnancy. Close monitoring and timely interventions are essential to ensure optimal outcomes for both mother and fetus.ConclusionsOur article puts forth the hypothesis that there is a link between lithium use during pregnancy and the occurrence of polyhydramnios and Nephrogenic Diabetes Insipidus (NDI), which may lead to severe obstetric and neonatal complications. This case report contributes to the limited literature on the subject and gives doctors practical advice that may help them make a better risk‐benefit analysis. Further research is warranted in order to refine risk assessment protocols and management strategies in this complex clinical scenario.

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“…39,45 In addition, a recent prospective cohort study suggested that the group with bipolar diagnosis exposed and nonexposed to lithium during pregnancy had similar obstetric complications and neonatal outcomes except lower Apgar scores in exposed group. 46…”

Section: Lithiummentioning

confidence: 99%

Prophylactic Management of Women With Bipolar Disorder During Pregnancy and the Perinatal Period

Uguz,

Sharma,

Boyce

et al. 2023

J Clin Psychopharmacol

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Many women with bipolar disorder experience episodes of illness or relapses over the perinatal period, especially in the immediate postpartum period. Risks associated with treated/untreated psychopathologies and fetal exposure to bipolar medications make the management of bipolar disorder during these periods challenging for clinicians and patients. In light of the available effectiveness and reproductive safety data, the current clinical update based on the opinions of a group of international perinatal psychiatry authors recommends general considerations and specific management strategies for each possible clinical scenario, including mixed features, predominant polarity, diagnosis of subtypes of bipolar disorder, severity of previous episodes, and risk of recurrence of mood episodes.

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Obstetric outcomes regarding the use of lithium in pregnant women with bipolar disorders: a prospective cohort study

Cited by 10 publications

References 34 publications

Neonatal admission after lithium use in pregnant women with bipolar disorders: a retrospective cohort study

Neonatal admission after lithium use in pregnant women with bipolar disorders: a retrospective cohort study

A case of pregnancy with severe polyhydramnios related to long‐term use of lithium

Prophylactic Management of Women With Bipolar Disorder During Pregnancy and the Perinatal Period

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