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Cited by 149Pregnancy and Medication ImpactPharmacological Effects and Toxicity StudiesFetal and Pediatric Neurological Disorders

Pregnancy Outcome Following In Utero Exposure to Lithium: A Prospective, Comparative, Observational Study

Diav-Citrin, Orna, Shechtman, Svetlana, Tahover, Esther, Finkel-Pekarsky, Victoriya, Arnon, Judy, Kennedy, Debra, Erebara, Aida, Einarson, Adrienne +1 more·2014·American Journal of Psychiatry
DOI 10.1176/appi.ajp.2014.12111402
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Abstract

OBJECTIVE: The authors conducted a prospective, comparative observational study to evaluate the risk of major anomalies following exposure to lithium during pregnancy. METHOD: A total of 183 lithium-exposed pregnancies of women who contacted the Israeli Teratology Information Service were followed up (90.2% in the first trimester) and compared with 72 disease-matched and 748 nonteratogenic-exposed pregnancies. RESULTS: There were significantly more miscarriages (adjusted odds ratio=1.94, 95% CI=1.08-3.48) and elective terminations of pregnancy (17/183 [9.3%] compared with 15/748 [2.0%]) in the lithium-exposed group compared with the nonteratogenic exposure group. The rate of major congenital anomalies after exclusion of genetic or cytogenetic anomalies was not significantly different between the three groups (lithium-exposed in the first trimester: 8/123 [6.5%]; bipolar: 2/61 [3.3%]; nonteratogenic: 19/711 [2.7%]). Cardiovascular anomalies occurred more frequently in the lithium group exposed during the first trimester when compared with the nonteratogenic exposure group (5/123 [4.1%] compared with 4/711 [0.6%]) but not after excluding anomalies that spontaneously resolved (3/123 [2.4%] compared with 2/711 [0.3%]). Ebstein's anomaly was diagnosed in one lithium-exposed fetus and in two retrospective lithium cases that were not included because contact with the information service was made after the prenatal diagnosis by ultrasound. The rate of noncardiovascular anomalies was not significantly different between the groups. The rate of preterm deliveries was higher in the lithium group compared with the nonteratogenic exposure group (18/131 [13.7%] compared with 41/683 [6.0%]). CONCLUSIONS: Lithium treatment in pregnancy is associated with a higher rate of cardiovascular anomalies. Women who are treated with lithium during organogenesis should undergo fetal echocardiography and level-2 ultrasound.

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Authors
Diav-Citrin, O., Shechtman, S., Tahover, E., Finkel-Pekarsky, V., Arnon, J., Kennedy, D., Erebara, A., Einarson, A., & Ornoy, A.
Affiliations
  • From the Israeli Teratology Information Service, Israel Ministry of Health, Jerusalem; the Hebrew University Hadassah Medical School, Jerusalem; MotherSafe, Royal Hospital for Women, Sydney, Australia; and the Motherisk Program, Hospital for Sick Children, Toronto.
  • Hebrew University of Jerusalem (IL)
ORCID
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
2014-07
Volume
171
Issue
7
Pages
785-794
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/appi.ajp.2014.12111402
OpenAlex
W2160231464
Cited by
149
References
37
Citations by year
2026: 1 · 2025: 7 · 2024: 21 · 2023: 8 · 2022: 5 · 2021: 11 · 2020: 15 · 2019: 15 · 2018: 8 · 2017: 15 · 2016: 25 · 2015: 15 · 2014: 3
FWCI
19.15
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmacological Effects and Toxicity Studies
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Fetal and Pediatric Neurological Disorders
Keywords
lithium, pregnancy, major congenital malformations, miscarriage, elective termination of pregnancy, cardiovascular anomalies, Ebstein's anomaly, preterm birth, fetal echocardiography, bipolar disorder, teratogenicity, first trimester exposure
MeSH terms
Abnormalities, Drug-Induced, Abortion, Spontaneous, Abortion, Eugenic, Adult, Bipolar Disorder, Female, Humans, Infant, Newborn, Obstetric Labor, Premature, Male, Pregnancy, Pregnancy Outcome, Pregnancy Trimester, First, Prenatal Exposure Delayed Effects, Risk Factors, Ultrasonography, Prenatal, Lithium Compounds

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