N Engl J Med. Sep 2, 2020 The prevalence of right ventricular obstruction defects in infants exposed to lithium was 0.60% compared with 0.18% among unexposed infants (adjusted risk ratio, 2.66; 95% CI, 1.0-7.1). Lithium was not significantly associated with noncardiac malformations, although the 95% confidence interval around the risk estimate indicates that some increase in risk cannot be ruled out.Our results support previous findings of an association between lithium use in pregnant women and cardiac defects in infants, although the magnitude of increased risk appeared considerably lower than originally suggested by the International Register of Lithium Babies.Our study also suggests that the association of lithium and cardiac malformations in humans is dose-dependent, with a risk that is increased by a factor of approximately 3 beyond doses of 900 mg per day. Women who stop Lithium in pregnancy have high rates of relapse. Background. That risk was nearly twice as high for babies exposed to lithium (27 percent) compared to those who weren’t (14 percent). Lithium is a mood stabiliser used in the treatment of bipolar disorder 1.The use of lithium in pregnancy was recently reviewed by the Medicines Adverse Reactions Committee (MARC) following the publication of new information 2..

It is mainly used to treat Close to 3 percent of Americans have bipolar disorder, according to the National Alliance on Mental Illness.For people with the condition, Bergink said, lithium is considered the most effective medication for stabilizing mood.However, she explained, its use has been limited in pregnant women and women who might become pregnant.That's because studies have linked the drug to a heightened risk of birth defects, such as malformations affecting the heart, particularly when it's used in the first trimester.But a "major challenge" in that kind of research is separating the effects of medication from any effects of the underlying mental health disorder, said Dr. Katherine Wisner, a perinatal psychiatrist and professor at Northwestern University in Chicago.The new study compared women who used lithium in the first trimester with women who also had bipolar disorder or depression but did not use the drug.
However, lithium has also been associated with risks during pregnancy for both the mother and the unborn child. First, although the availability of detailed maternal information through the MAX data set and our propensity-score adjustment allowed for control for a large number of confounders, we cannot rule out the possibility of residual confounding by characteristics that are not captured or are incompletely captured in our database.

The adjusted risk ratio for cardiac malformations among infants exposed to lithium as compared with unexposed infants was 1.65 (95% confidence interval [CI], 1.02 to 2.68). Fourth, because the cohort included live births only, we examined the potential effect of different proportions of terminations among women treated with lithium versus those untreated within levels of covariates used in the adjustment.The study cohort included 1,325,563 pregnancies that met the inclusion criteria.

If this happens to you, make sure your obstetrician or GP checks your Lithium level as soon as possible. They also need to know what else they can do to help you stay as well as possible.Again, do not stop Lithium without getting advice.

There has been specific concern about whether using Lithium in pregnancy increases the risk of heart defects in babies. This will help you stay as well as possible and make sure that you and your family have all the help and support you need.Your psychiatrist should talk to your obstetrician and midwife. That relapse, she noted, may result in mania, depression, psychosis or self-harm.Bergink said some options during pregnancy can include lowering the lithium dose, or going off the drug during the first trimester, then starting again -- all done under medical supervision.There are other medications for bipolar disorder. Fifth, because the cohort was restricted to live births, spontaneous abortions or planned terminations due to congenital malformations that were diagnosed early in pregnancy were missed.

Dose-dependent teratogenicity of lithium was previously reported in rodent models,Limitations of our study warrant consideration.

It is known that about one in every 100 babies is born with a heart defect, regardless of whether or not their mother took medicines during pregnancy.

So, your Lithium level will need to be measured more often than usual.