Update on the Management of Lithium in the Peripartum Period

Lithium salts are the first-line maintenance treatment for bipolar disorders in most guidelines and also are used in the indication of difficult-to-treat depression and chronic suicidality. With increasing age of childbearing at least in middle and high income countries, a substantial number of bipolar women are treated with mood stabilizers, and amongst those often lithium is used, at the time they wish to get pregnant. As there is no easy alternative for lithium and especially if previous discontinuation attempts have failed, pregnancy and also breastfeeding needs to be considered during ongoing treatment with lithium. In former times, lithium exposure during pregnancy was thought to be a rather strong embryotoxic substance, especially increasing the risk of severe cardiac malformation. However, combined data of several recent studies only point to a low teratogenic risk and there is scarce but rising evidence of the optimal dosing of lithium during pregnancy. Furthermore, mothers often prefer to breastfeed their children. However, there is indeed evidence that lithium transfers to the breastmilk and can also be detected in the infant’s serum. The influence on the infant is still a largely understudied topic, even if no major negative long term effects have been reported. Regular monitoring of the infant’s renal clearance, thyroid function, and lithium levels is warranted, when breastfeeding under lithium exposure.

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Artikel online veröffentlicht:
12. März 2024