American researchers have recently published a systematic review and meta-analysis examining the safety, efficacy and risks associated with lithium treatment during pregnancy and the postpartum period for women with bipolar disorder. Following analysis of thirteen studies included in quantitative analysis, researchers concluded that lithium use during pregnancy was linked to increased odds of any congenital anomaly (N=23,300, odds ratio (OR) =1.81, 95% CI=1.35–2.41; number needed to harm (NNH) = 33, 95% CI=22–77) and of cardiac anomalies (N=1,348,475, OR=1.86, 95% CI = 1.16–2.96; NNH=71, 95% CI = 48–167). In addition, exposure during the first trimester was linked to increased odds of spontaneous abortion (N=1,289 OR = 3.77, 95% CI = 1.15–12.39; NNH = 15, 95% CI=8–111). When addressing postpartum relapse prevention, lithium exposure was more effective when compared to no lithium (N=48, k=2; OR=0.16, 95% CI=0.03–0.89; number needed to treat=3, 95% CI=1–12). It was also determined that newborns were more reactive, without a heightened risk of cardiac anomalies, in mothers with serum lithium levels <0.64 mEq/L and dosages <600 mg/day. It was concluded that although the overall risk linked to lithium treatment is low, risk was increased during the first trimester or with higher dose exposure. The researchers advise that pregnancy and lithium use in women with bipolar disorder should be planned with care to ensure optimal outcomes are met for each individual. The original research, published in the American Journal of Psychiatry, can be viewed here.

Contributed by Australian Medication Safety Services Associate – Isabella Singh