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Is it safe? · Pregnancy Smart

Lithium During Pregnancy: Bipolar Disorder Safety

Assigned clinical reviewerMatt Stahl· PharmDDraft · pending clinical reviewUpdated

What does the evidence say about lithium during pregnancy?

  1. MotherToBaby reports that some first-trimester studies suggest a small increase in heart defects, especially Ebstein anomaly, while other studies have not found an increase; it also advises against changing lithium without the care team. 1
  2. In a Medicaid cohort of 1,325,563 pregnancies, 16 of 663 lithium-exposed infants had cardiac malformations (2.41%) versus 1.15% of unexposed infants; the adjusted risk ratio was 1.65, with a higher estimate above 900 mg daily. 2
  3. A six-cohort meta-analysis of 727 lithium-exposed pregnancies found a higher rate of major malformations after first-trimester exposure than in mood-disorder reference pregnancies, while its specified pregnancy and delivery complications were not higher. 3
  4. In a serial pharmacokinetic study of three pregnant patients with bipolar disorder, average lithium clearance was 63.5% higher in the third trimester than at baseline and returned to baseline four to nine weeks postpartum; this small study measured maternal blood, not fetal exposure or birth outcomes. 4
  5. A retrospective study of 101 women who stopped lithium found recurrence in 52% of pregnant participants during the next 40 weeks and more recurrence after rapid than gradual discontinuation; it had no continued-lithium pregnancy comparator and cannot establish the best plan for an individual. 5

Is lithium safe in each trimester?

  • First trimester. First-trimester lithium exposure is the period studied for cardiac malformations. Contact the prescribing clinician promptly after a positive test, but do not abruptly stop lithium because rapid discontinuation can bring bipolar symptoms back.
  • Second trimester. Pregnancy-related changes in fluid balance and kidney handling can change lithium levels. MotherToBaby says clinicians may check blood levels throughout pregnancy and adjust the plan as needed.
  • Third trimester. Near birth, tell the obstetric and newborn teams about lithium. Newborn sleepiness, low muscle tone, breathing or feeding difficulty, and jaundice have been reported, particularly with exposure near delivery and high maternal levels.

Frequently asked questions

Can I stay on lithium during pregnancy?

Whether lithium remains part of a pregnancy plan depends on bipolar history, prior response, dose, alternatives, and pregnancy stage. Lithium has a small cardiac-malformation signal, but sudden discontinuation can bring symptoms back. A psychiatrist and obstetric clinician should make the plan together.

What birth defects are associated with lithium in the first trimester?

Lithium studies mainly identify a small increase in cardiac malformations, including right-ventricular-outflow abnormalities and Ebstein anomaly in some reports. The Medicaid cohort found 2.41% of lithium-exposed infants had cardiac malformations, compared with 1.15% of unexposed infants.

Should I stop lithium before trying to conceive?

Do not stop lithium independently before conception. MotherToBaby says it can take about nine days on average for most lithium to clear in healthy nonpregnant adults, but the decision must also weigh the risk of bipolar symptoms returning after a change.

Does a higher lithium dose change the pregnancy finding?

In the Medicaid cohort, the adjusted cardiac-malformation estimate was highest above 900 mg daily. Lower-dose estimates had wide confidence intervals, so that group finding cannot identify a safe personal dose. Lithium dose changes require the prescribing clinician and blood-level monitoring.

Will lithium levels change during pregnancy?

Lithium levels can change as pregnancy changes fluid balance and kidney handling. MotherToBaby says clinicians can check lithium blood levels throughout pregnancy and adjust when needed. The monitoring schedule and any dose change must be individualized by the prescribing team.

Does lithium exposure require a fetal heart scan?

MotherToBaby says prenatal ultrasound can screen for some structural findings, including Ebstein anomaly. A clinician who knows the timing and dose of lithium exposure can decide whether routine imaging, targeted cardiac imaging, or another assessment is appropriate for that pregnancy.

What should a lithium delivery plan include?

A lithium delivery plan should coordinate psychiatry, obstetrics, and newborn care. It should address maternal lithium-level monitoring and ensure newborn observation for feeding, breathing, muscle-tone, thyroid, or kidney concerns when indicated. The timing of any dose change near birth belongs in the prescriber's individualized plan.

Can I breastfeed while taking lithium?

Lithium passes into breast milk. MotherToBaby reports that infant lithium, thyroid, and kidney monitoring has been recommended, especially for very young or preterm infants, and notes that the product label advises against breastfeeding. Postpartum decisions need both the infant clinician and prescriber.

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References

  1. Lithium

    MotherToBaby · https://mothertobaby.org/fact-sheets/lithium-pregnancy/

  2. Lithium Use in Pregnancy and the Risk of Cardiac Malformations

    NIH PMC · https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5667676/

  4. Lithium Pharmacokinetics in the Perinatal Patient With Bipolar Disorder

    PubMed · https://pubmed.ncbi.nlm.nih.gov/35620848/

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.