This article is more than 5 years old. Information may no longer be current.
First-trimester lithium exposure increases risk for birth defects
Click Here to Manage Email Alerts
Fetuses exposed to lithium during the first-trimester had elevated risk for major congenital malformations, according to results from a large meta-analysis.
However, the absolute risk for defects was much smaller than reported in previous research, according to findings published in The Lancet Psychiatry.
“Lithium treatment can reduce the risk for relapse both in pregnancy and in the postpartum period,” Veerle Bergink, MD, PhD, of the departments of psychiatry and obstetrics, gynecology and reproductive science at Icahn School of Medicine at Mount Sinai, and colleagues wrote. “However, concerns about teratogenicity, maternal- and offspring complications ... limit its use.”
Researchers examined in-utero lithium exposure and risk for pregnancy complications, delivery outcomes, neonatal morbidity and congenital malformations in a meta-analysis of data from Denmark, Canada, Netherlands, Sweden, the U.K. and the U.S. Specifically, they compared data from 727 lithium-exposed pregnancies with 21,397 reference pregnancies in unexposed mothers with mood disorders to determine pregnancy complications, delivery outcomes, neonatal readmission to hospital within 1 month of birth, and major and cardiac malformations.
Analysis revealed infants exposed to lithium during the first trimester were more likely to have major malformations (7.4% vs. 4.3% [adjusted OR = 1.71; 95% CI, 1.07–2.72]). Lithium-exposed children were also more likely to have major cardiac malformations, but this was not statistically significant (2.1% vs. 1.6% [adjusted OR = 1.54; 95% CI, 0.64–3.7]). Lithium-exposed patients were also at higher risk for neonatal readmission compared with the reference group (27.5 vs. 14.3% [adjusted OR = 1.62; 95% CI, 1.12–2.33]).
Lithium exposure was not linked with pregnancy complications or delivery outcomes, including pre-eclampsia, preterm birth, gestational diabetes, or low birth weight, according to the results. Importantly, the large population size of this study allowed Bergink and colleagues to see that the absolute risk for birth defects in lithium-exposed infants was lower than previously believed.
“Women should be informed on malformation risk in first-trimester exposed infants, but also about very high relapse risks for mental illness both during pregnancy and during the postpartum period,” Bergink said in a press release. “Given the well-documented effectiveness of lithium in reducing relapse in the perinatal period, some important clinical considerations are either to continue lithium in a lower dose during the first trimester or to restart lithium after the first trimester or immediately postpartum.” – by Savannah Demko
Disclosure: Bergink reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.