Lithium Use During Early, Late Pregnancy, and Breastfeeding

Lithium salts are regularly used in the treatment for bipolar disorder, both as a prophylactic and as an episodic treatment agent. Bipolar affective disorder is most common in women of childbearing age. The available evidence indicate that lithium at therapeutic dose levels poses only a small but measurable teratogenic hazard to human reproduction being the main teratogenic target the cardiovascular system. The specific defect associated with lithium exposure, the Ebstein anomaly, may be serious or life threatening. In addition, the continuous use throughout gestation is associated with perinatal complications including toxicity and transient neurodevelopment deficits in the neonatal period. Since there is no controlled data in human pregnancy, lithium should only be given during pregnancy when there are no alternatives and benefit outweighs risk. Whenever lithium is the drug of choice in women with bipolar disorder it may be continued during pregnancy although these lithium-treated women should be considered high risk and need to be monitored during pregnancy including fetal echocardiography and serum Li levels throughout pregnancy.