Lithium: Managing Bipolar Disorder in Childbearing Women

Course overview

Bipolar disorder is a common and serious psychiatric condition, which often has disabling consequences for those afflicted by it. Women have the highest risk of being diagnosed with bipolar or having a recurring episode during pregnancy or within one year of giving birth. During pregnancy and the postpartum period, lithium has been identified as an effective treatment to control symptoms of bipolar disorder and as a prevention of a relapse of symptoms. Fluctuations in serum lithium levels may occur during pregnancy and the postpartum period that can lead to subtherapeutic or supratherapeutic lithium levels. In addition, there are risks with lithium use during pregnancy for the mother and fetus. During the first trimester of pregnancy, there is a potential for congenital malformations due to lithium exposure in utero. There may also be an increased risk of miscarriage from lithium use. The decision to prescribe lithium during pregnancy should be determined by considering the risk factors of using lithium and balancing them with the risk of mood dysregulation and psychosis for the mother. Continuing lithium use during pregnancy requires close monitoring during the perinatal period, including frequent testing of lithium serum levels. Consideration must also be made for mothers who intend to breastfeed.