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Obstetric outcomes regarding the use of lithium in pregnant women with bipolar disorders: a prospective cohort study

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Abstract

Lithium is the mood stabilizer of choice for the prevention of bipolar relapse over the perinatal period. A critical issue is its safety of the mother and the developing fetus. This study aims to compare obstetric outcomes in women with bipolar disorders (BD) regarding treatment with lithium during pregnancy. We enrolled a cohort of pregnant women with BD that received care at the Perinatal Mental Health Unit of a tertiary hospital between January 2005 and March 2017. The exposed group received lithium during pregnancy, whereas the unexposed group did not. The main outcomes were obstetric complications during pregnancy, during labor and delivery, neonatal complications, and congenital malformations. Demographic and clinical data were described using measures of frequency, central tendency, and dispersion. Between-group differences were calculated with chi-square, Fisher’s test, t-tests, or Mann–Whitney U test. Our cohort included 100 pregnant women with BD: 53 (53%) used lithium during pregnancy, and 47 (47%) did not. There were no significant differences in obstetric complications, neonatal complications, or congenital anomalies. Nonetheless, newborns of lithium-treated women had lower Apgar scores at 1 min (mean 8.2 ± 1.6 vs. 8.9 ± 0.6, p = 0.026) and 5 min (9.6 ± 0.8 vs. 9.9 ± 0.5, p = 0.015). Our findings do not identify worse obstetric outcomes in women with BD that take lithium during pregnancy, except for an impact on newborn Apgar scores. Lithium might be an adequate treatment for pregnant women with BD, especially for those with a high recurrence risk, and always after an individualized risk–benefit assessment.

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Acknowledgements

EV thanks the support of the Spanish Ministry of Science and Innovation (PI15/00283, PI18/00805) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER), the Instituto de Salud Carlos III, the CIBER of Mental Health (CIBERSAM), the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), the CERCA Programme, and the Departament de Salut de la Generalitat de Catalunya for the PERIS grant SLT006/17/00357.

Funding

Bipolar Disorder Unit has been supported by the Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiveness, Spain; a grant within the Plan Nacional de I + D + I financed by ISCIII-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER), Instituto de Salud Carlos III, Subdirección General de Evaluación y Fomento de la Investigación; Fondo Europeo de Desarrollo Regional. Unión Europea, “Una manera de hacer Europa”; CIBERSAM; and the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2014_SGR_398).

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Author notes

  1. Maria Sagué-Vilavella and Eva Solé contributed equally.

Authors and Affiliations

  1. Bipolar and Unipolar Disorders Unit, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain

    Maria Sagué-Vilavella & Eduard Vieta

  2. Institute of Neuroscience, Perinatal Mental Health Unit, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain

    Eva Solé, Ester Roda & Alba Roca

  3. August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Catalonia, Spain

    Eva Solé, Ana Sandra-Hernández, Ester Roda, Eduard Vieta & Alba Roca

  4. Department of Medicine, School of Medicine, University of Barcelona, Barcelona, Catalonia, Spain

    Eva Solé, Justo Pinzón-Espinosa, Ana Sandra-Hernández & Eduard Vieta

  5. Department of Mental Health, Parc Tauli University Hospital, Sabadell, Barcelona, Spain

    Justo Pinzón-Espinosa

  6. Department of Clinical Psychiatry, School of Medicine, University of Panama, Panama, Spain

    Justo Pinzón-Espinosa

  7. Department of Maternal-Fetal Medicine, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain

    Ana Sandra-Hernández

  8. Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain

    Eduard Vieta

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  1. Maria Sagué-Vilavella
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  2. Eva Solé
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  7. Alba Roca
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Contributions

ES conceived the study. ASH, ES, AR, and LLGE contributed data. ES and MSV performed the analyses. ES, MSV, and JPE drafted the manuscript. All authors critically revised the manuscript and approved the final version to be published.

Corresponding author

Correspondence to Eva Solé.

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Conflict of interest

MSV has received financial support for CME activities and travel funds from Janssen-Cilag and Lundbeck and reports no financial or other relationship relevant to the subject of this article. JEPE has received honoraria for CME speaker from Lundbeck, none relevant to this study. EV has received grants and served as consultant, advisor, or CME speaker for the following entities (unrelated to the present work): AB-Biotics, Abbott, Allergan, Angelini, Dainippon Sumitomo Pharma, Ferrer, Gedeon Richter, Janssen, Lundbeck, Otsuka, Sage, Sanofi-Aventis, and Takeda. The other authors declare nothing to disclose.

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Sagué-Vilavella, M., Solé, E., Pinzón-Espinosa, J. et al. Obstetric outcomes regarding the use of lithium in pregnant women with bipolar disorders: a prospective cohort study. Arch Womens Ment Health 25, 729–737 (2022). https://doi.org/10.1007/s00737-022-01234-8

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  • DOI: https://doi.org/10.1007/s00737-022-01234-8

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