Perinatal and Neonatal Outcomes of Lithium-Treated and Untreated Bipolar Women During Pregnancy: A Review of Present Literature

摘要

Many women with a bipolar disorder are in their reproductive age and will need to continue their psychopharmacological treatment during pregnancy, being abrupt discontinuation of these medications associated with an increase of the probability of relapse, high-risk behaviours, significant family dysfunction, and suicide. Lithium is a first line drug for acute and maintenance treatment of bipolar disorder. Its teratogenic and perinatal effects are controversial, so as its longterm effects on neurodevelopment of the children. Our purpose is to review the most up-to-date literature dealing with growth, neurological, cognitive and behavioural development of children exposed to Lithium in utero. A PubMed search was performed with the following keywords: bipolar disorder, Lithium, pregnancy, lactation, perinatal disease, child development. Studies were included in the review if they investigated one or more of the adverse events of interest. Of the 26 studies included in our review, some show an association between Lithium treatment and several grades of malformations (most commonly minor), both cardiac and involving other organs, and dysfunctions which are often reversible. Some studies reported no collateral effects due to in utero exposure to Lithium. Even though literature points out a slightly increased risk of major malformations due to Lithium therapy during pregnancy, the drug should not be discontinued, yet monitoring of serum Lithium levels and foetal echocardiography are recommended.