Use of lithium in pregnancy & breastfeeding

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Risk and consent
  • Ideally avoid in pregnancy as lithium carries a known risk of teratogenic effects.
  • Discuss risks and benefits in all women of childbearing potential considering lithium treatment.
  • The discussion should include contraceptive advice.
  • Document this discussion and subsequent consent.
  • 'BUMPS' website should be used to reinforce verbal information
Managing patients who become pregnant while taking lithium

If a woman taking lithium becomes pregnant take the following actions

  • Confirm the pregnancy as early as possible.
  • Seek advice on management from the Peri-natal service.
  • If pregnancy is confirmed in the first trimester and the woman is stable, consider stopping lithium gradually over 4 weeks and inform the woman that this may not remove the risk of cardiac defects in the foetus.
  • Consider offering an antipsychotic as prophylactic medication.
  • Offer appropriate screening and counselling about the continuation of pregnancy, the need for additional monitoring and the risk to the foetus of remaining on lithium.
  • Record details of all advice given and the woman's consent to treatment.

If lithium treatment is to continue:

  • Check lithium levels every 4 weeks
  • Then weekly from the 36th week
  • ThenĀ less than 24 hours after child birth
  • The dose should be adjusted to keep levels within the therapeutic range
  • The newborn baby should have a full paediatric assessment and social and medical help should be providedĀ  for the mother and child

More information on the use of lithium in pregnancy is available in appendix 3 of the attached lithium standards

Breastfeeding

Women on lithium who wish to breast feed should

  • Be given advice on the risks and benefits of breast feeding.
  • Be advised not to if taking lithium and an alternative prophylactic agent should be offered.
Editorial Information

Last reviewed: 03 September 2019

Next review: 12 July 2021

Author(s): PMG-MH

Version: 1

Approved By: PMG-MH

Reviewer Name(s): Andrew Walker, Suzanne Burke