Generally, it is advisable to avoid any pharmacological interventions during pregnancy. In some cases, it may be appropriate for women experiencing episodes of depression and/or mania to continue their lithium treatment in order to stay well.
Risks of Using Lithium in Pregnancy
- First trimester – there is a small risk of congenital problems, including serious heart malformation.
- Second trimester – there continues to be a risk of congenital problems, but not to the same degree as in the first trimester.
- Third trimester – towards the end of this trimester, the mother is more at risk of lithium toxicity.
- Childbirth – both mother and baby are at greater risk to lithium toxicity, as the kidneys filter lithium differently in labor.
- Lithium has also been implicated in occurrences of still-births and prenatal death.
Risks of Stopping Lithium in Pregnancy
- Relapse – relapse of serious mental illness can be dangerous to a fetus. Risks include poor self-care, drug misuse (including alcohol), disturbed behaviours, self-harm and suicide.
- Relapse treatment – acute relapse may require treatment that is dangerous to the unborn child.
Using Lithium in Pregnancy and Childbirth
Taking lithium during pregnancy should be an informed decision - it is important that women affected are able to discuss the benefits and risks of continuing or discontinuing their treatment. In the case of unplanned pregnancies, women may require advice on possibly terminating the pregnancy.
Those planning to get pregnant should discuss this with their doctor. It is generally recommended that women come off lithium slowly over number of weeks, thereby reducing the risks associated with early pregnancy. They may then be advised to monitor their mood for a few weeks before conceiving.
Due to the aforementioned risks, lithium is sometimes avoided in the first trimester, however, some women may continue with lithium for most of their pregnancy. This may be more likely when pregnancies are unplanned. A level II ultrasound and fetal echocardiography may be suggested at 18-20 weeks to monitor for signs of congenital problems.
Lithium treatment in pregnancy is tailored to the minimum dose required to maintain functioning. Mental state and lithium levels in the blood have to be carefully monitored. Women must be aware of how the body uses lithium during pregnancy, including an understanding of symptoms to look out for.
Lithium should be stopped before childbirth, and is sometimes gradually reduced before the due date. In some cases, women may take lithium for longer, stopping it at the start of labor.
Lithium after Pregnancy and Breastfeeding
Women may be advised to start lithium again a few days after delivery, as they are at increased risk of illness relapse. Lithium is generally not recommended for breastfeeding mothers, as it passes into breast milk, but there is no long-term research data available.
Read Lithium Toxicity or Poisoning for information on lithium monitoring and symptoms of toxicity. Those prescribed lithium who are pregnant or planning pregnancy should discuss their options with a qualified health practitioner and any other professionals involved in their care.
Sources
Lithium in Pregnancy, British Journal of Psychiatry (Psychiatric Bulletin), published in 2000, authors: Williams. K, Oakes. S
Lithium in pregnancy, childbirth and afterwards, Mind, accessed 21st June 2008, author: Darton. K
Lithium: Drugs in Pregnancy and Lactation, Drug Safety Site.com, accessed 21st June 2008, author: not specified
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