Journal Article

Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study

Sundström-Poromaa, Inger, Wikström, Anna-Karin, Tong, Stephen, Hiscock, Richard, Hastie, Roxanne, Lindquist, Anthea, Lindström, Linda

2021

Overview

Background Lithium is prescribed during pregnancy, but there is limited information about pregnancy and neonatal outcomes following in utero exposure. Thus, this study aimed to investigate the associations between lithium use and adverse pregnancy and neonatal outcomes. Methods This population-based cohort study examined associations between maternal lithium use and major adverse pregnancy and neonatal outcomes via inverse probability weighted propensity score regression models. Results Of 854,017 women included in this study, 434 (0.05%) used lithium during pregnancy. Among pre-specified primary outcomes, lithium use during pregnancy was associated with an increased risk of spontaneous preterm birth (8.7% vs 3.0%; adjusted relative risk [aRR] 2.64 95% CI 1.82, 3.82) and birth of a large for gestational age infant (9.0% vs 3.5%; aRR 2.64 95% CI 1.91, 3.66), but not preeclampsia nor birth of a small for gestational age infant. Among secondary outcomes, lithium use was associated with an increased risk of cardiac malformations (2.1% vs 0.8%; aRR 3.17 95% CI 1.64, 6.13). In an analysis restricted to pregnant women with a diagnosed psychiatric illness ( n =9552), associations remained between lithium and spontaneous preterm birth, birth of a large for gestational age infant, and cardiovascular malformations; and a positive association with neonatal hypoglycaemia was also found. These associations were also apparent in a further analysis comparing women who continued lithium treatment during pregnancy to those who discontinued prior to pregnancy. Conclusions Lithium use during pregnancy is associated with an increased risk of spontaneous preterm birth and other adverse neonatal outcomes. These potential risks must be balanced against the important benefit of treatment and should be used to guide shared decision-making.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Age / Biomedicine / Bipolar / Bipolar disorder / Birth / Birth weight / Body mass index / Childbirth & labor / Codes / Cohort analysis / Cohort Studies / Complications and side effects / Congenital diseases / Country of birth / Decision making / Diabetes / Diseases / Drug therapy / Education / Female / Gestational age / Health aspects / Humans / Hypertension / Hypoglycemia / Infant, Newborn / Infants / Infants (Newborn) / Intrauterine exposure / Lithium / Lithium - adverse effects / Medicine / Medicine & Public Health / Neonates / Newborn babies / Parturition / Perinatal psychiatry / Population / Population studies / Population-based studies / Pre-eclampsia / Pregnancy / Pregnancy Outcome - epidemiology / Pregnancy, Complications of / Pregnant women / Premature birth / Premature Birth - chemically induced / Premature Birth - epidemiology / Prenatal drug exposure / Preterm birth / Psychosis / Psychotropic drugs / Regression analysis / Regression models / Research Article / Risk / Risk factors / Schizophrenia / Shared decision making / Small for gestational age / Statistical analysis / Statistics / Sweden - epidemiology / Womens health