Expert: Ivan Goldberg, M.D. - 3/6/2005

Question
I'm taking Lithium 300mgx4/day and concidering getting pregnant soon.Is it harmful to unborn child?

Answer
Hi . . .

There is no simple answer to your question. Here are a few abstracts from the medical literature on the topic:

1: J Toxicol Clin Toxicol. 2001;39(4):381-92. Related Articles, Links  


The effects of lithium, valproic acid, and carbamazepine during pregnancy and lactation.

Iqbal MM, Sohhan T, Mahmud SZ.

Department of Psychiatry & Behavioral Neurobiology, The University of Alabama at Birmingham, 35294-0017, USA. miqbal@uabmc.edu

The chronic, complex, and episodic course of bipolar mood disorder presents a particularly formidable challenge to the clinician making a treatment plan for the onset or recurrence of the illness during pregnancy and lactation. Women treated with anti-manic drugs who become pregnant are commonly considered to be at high risk for fetal complications during the pregnancy or during lactation. The risks of antimanic drug use during pregnancy include teratogenic effects, direct neonatal toxicity, and the potential for longer-term neurobehavioral sequela. The use of medications during pregnancy and lactation requires critical attention to the timing of exposure, dosage, duration of use, and fetal susceptibility. The postnatal period is a time of increased onset and relapse of mental illness. No antimanic drug can be proven completely safe. Prescribing antimanic medications with a long safety record, avoiding exposure in the first trimester; avoiding multidrug regimens, and prescribing the lowest dose for the shortest duration will minimize the fetal risk. This review considers treatment with lithium, valproic acid, and carbamazepine. It assesses the risk to the fetus, the perinatal risks for the infant, the risks associated with treatment during the puerperium and breast-feeding, and the risks to the later development of the child.

Publication Types:
Review
Review, Tutorial

PMID: 11527233 [PubMed - indexed for MEDLINE]

--------------------------------------------------------------------------------


2: J Clin Psychiatry. 1998;59 Suppl 6:57-64; discussion 65. Related Articles, Links  


The use of lithium and management of women with bipolar disorder during pregnancy and lactation.

Llewellyn A, Stowe ZN, Strader JR Jr.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA.

The introduction of lithium salts almost a century ago and the subsequent approval of lithium carbonate for the treatment of patients with bipolar disorder represent one of the cornerstones of modern psychopharmacology. The onset of bipolar disorder in women often occurs during the childbearing years, which complicates the treatment decisions secondary to the possibility of conception while taking medication. The establishment of the lithium registry for fetal teratogenesis in the late 1960s ushered in a heightened level of concern for the use of lithium during the reproductive years; although, in the years to come, it has become apparent that alternative pharmacologic treatments for bipolar disorder may exceed the teratogenic risk of lithium monotherapy. In this paper, the available data on the use of antimanic medications during pregnancy and lactation are reviewed with an emphasis on providing a realistic risk/benefit assessment for medication selection and management of these patients. Treatment strategies are discussed for (1) women who are contemplating pregnancy (2) women who inadvertently conceive while taking medications (3) women who choose to become pregnant while taking medication, and (4) women who intend to breastfeed while taking medications.

Publication Types:
Review
Review, Tutorial

PMID: 9674938 [PubMed - indexed for MEDLINE]

--------------------------------------------------------------------------------


3: Pharmacopsychiatry. 1992 Jul;25(4):187-91. Related Articles, Links  


Bipolar illness, lithium prophylaxis, and pregnancy.

van Gent EM, Verhoeven WM.

Willem Arntsz Huis, Utrecht, The Netherlands.

In advising bipolar patients wishing to become pregnant, Weinstein's guidelines were extended to seven stages: contraceptive measures; genetic counseling; discontinuing lithium in the first trimester or prescribing alternatives; ultrasound scanning for congenital anomalies, low lithium levels during pregnancy; discontinuing lithium at the end of pregnancy; starting immediately after birth, no breast feeding, observation of the neonate in the neonatal ward; and close observation of the patient in the follow-up year. Of the 15 bipolar patients, 11 gave birth to healthy children (five of them twice). Most patients knew nothing about the inheritance of bipolar illness. Four made no further attempt to become pregnant: two in view of a serious possibility of inheritance, the other two after a severe relapse. Three patients chose an alternative to lithium medication (carbamazepine and haloperidol). Postpartum, 27% of the patients who used medication relapsed and 60% of the patients who used none relapsed.

PMID: 1528958 [PubMed - indexed for MEDLINE]

--------------------------------------------------------------------------------


4: J Clin Psychiatry. 1990 Oct;51(10):410-3. Related Articles, Links  


Lithium treatment during pregnancy, delivery, and lactation: an update.

Schou M.

Psychiatric Hospital, Risskov, Denmark.

Because prophylactic lithium treatment is often given to manic depressive women of fertile age, the answers to five questions are pressing: (1) Does lithium administration during pregnancy expose the unborn child to risk of malformations? (2) Does such exposure lead to later developmental anomalies? (3) Do changes in the pharmacokinetics of lithium during pregnancy and delivery require special precautions? (4) Does lithium treatment during pregnancy exert other effects? (5) Is it advisable that women in lithium treatment breastfeed their infants? The author discusses these questions in the light of present-day knowledge and proposes guidelines for lithium treatment during pregnancy, delivery, and lactation.

Publication Types:
Review
Review, Tutorial

PMID: 2211538 [PubMed - indexed for MEDLINE]

Best regards . . .

Ivan
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%