Lithium use in women with bipolar disorder during peripartum
Background Lithium use during peripartum requires careful consideration due to a risk of teratogenic effects, adverse side effects and risk of neonatal complications. However, given the effectiveness of lithium, use during the peripartum period may be indicated.
Aim To provide an overview of the current evidence regarding the clinical use of lithium during peripartum, including risk of relapse in case of (dis)continuation and evolution of lithium levels.
Method A review was performed in the Medline and ScienceDirect database.
Results Ten studies were included. Six studies concerned the risk of relapse in case of (dis)continuation of lithium during the peripartum. Four studies concerned the evolution of lithium levels throughout the peripartum. Lithium discontinuation during pregnancy leads to an increased risk of relapse during pregnancy and postpartum. At the same dose, lithium levels are lower than preconceptual in all trimesters.
Conclusion Risk and benefits of lithium use during the peripartum should be carefully considered, if possible prior to conception. Close monitoring of maternal lithium levels and renal function is necessary due to significant fluctuations during peripartum.