How to Use Lithium During Pregnancy & Postpartum?

Lithium is considered a gold-standard mood stabilizer for the management of bipolar disorder.

How about managing bipolar disorder with lithium during pregnancy OR for a woman who is stable on lithium & becomes pregnant?

Studies have shown that relapse risk increases (almost doubles) if lithium is discontinued during pregnancy. Lithium treatment during pregnancy is not only important to maintain euthymia but also to reduce the risk of postpartum relapse.

This post will summarize a brief overview of how to use lithium during and after pregnancy:

DURING PREGNANCY:
  • Maintain a target lithium concentration at the minimum effective level for mother during pregnancy.
  • The first and second trimester are characterized by a significant decrease in blood levels for lithium.
  • Lithium level should be monitored on a monthly basis during first and second trimester.
  • In the third trimester, weekly monitoring of lithium blood levels is recommended.
  • Gradual decline in lithium serum concentrations occurs throughout pregnancy, with lithium levels in the third trimester being 34% lower than the non-pregnant levels, necessitating a 50% increase in the lithium dose to maintain stable levels. 
DURING & AFTER DELIVERY:
  • Preferably, lithium blood levels should be measured before and 24 hour after delivery.
  • Lithium blood level, TSH and free T4 should be evaluated in umbilical cord blood sample.
  • Obtain lithium blood levels twice weekly during the first 2 weeks postpartum.
INTERESTED IN LEARNING MORE?
READ THE FOLLOWING COURSE CHAPTER FOR MORE DETAILS:

Women’s Mental Health:

Lithium During Pregnancy & Postpartum

This chapter will summarize the use of lithium in pregnancy in the following eight sections:

(1) Guidelines for lithium administration during pregnancy and postpartum.

(2) Lithium and Ebstein’s Anomaly: Estimated Risk; Clinical Features; Diagnostic Test.

(3) Lithium and cardiovascular malformations from Lithium Baby Register & studies in 1970.

(4) Re-evaluation of risk of in utero exposure to lithium.

(5) Pregnancy outcome following in utero exposure to lithium: prospective, comparative, observational study.

(6) Is this association of lithium and cardiac malformations dose-dependent?

(7) Prospective multicentre study of pregnancy outcome after lithium exposure during first trimester.

(8) Lithium Placental Passage and Obstetrical Outcomes.

References:
  1. Am J Psychiatry. 2005 Nov;162(11):2162-70. 
  2. BMJ Open. 2017 Mar 1;7(3):e015738. 
  3. Am J Psychiatry. 2005 Nov;162(11):2162-70.
  4. Int J Bipolar Disord. 2018; 6: 26.
  5. Am J Psychiatry. 2007a;164(12):1817–24

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