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Cardiovascular anomalies, miscarriages more common in lithium-exposed pregnancies

Pregnant women taking lithium were more likely to miscarry or electively terminate pregnancy, according to a study published in The American Journal of Psychiatry.

Orna Diav-Citrin, MD, of the Israel Ministry of Health, and colleagues assessed 183 lithium-exposed pregnancies, 748 nonteratogenic-exposed pregnancies and 72 disease-matched pregnancies. Participants were prospectively followed up after delivery.

Women taking lithium had significantly more miscarriages (adjusted odds ratio=1.94, 95% CI=1.08-3.48) and elective terminations of pregnancy (9.3% vs.2%) compared with those with nonteratogenic-exposed pregnancies. Cardiovascular abnormalities occurred more frequently among those with pregnancies exposed to lithium in the first trimester than those not exposed (4.1% vs. 0.6%). Similarly, preterm delivery occurred more often in women with lithium-exposed pregnancies (13.7%) than those unexposed (6%). The rate of major congenital and non-cardiovascular abnormalities was not significantly different between lithium-exposed and unexposed pregnancies.

“Lithium treatment in pregnancy is associated with a higher rate of cardiovascular anomalies. Women who are treated with lithium during organogenesis should undergo fetal echocardiography and level-2 ultrasound,” Diav-Citrin and colleagues concluded.