Obstetric Outcomes in Women on Lithium: A Systematic Review and Meta-Analysis

Author:

Callovini Tommaso12ORCID,Montanari Silvia12,Bardi Francesca12ORCID,Barbonetti Sara12,Rossi Sara12,Caso Romina12,Mandracchia Giuseppe12,Margoni Stella12,Brugnami Andrea12ORCID,Paolini Marco3,Manfredi Giovanni4ORCID,Giudice Luca Lo12ORCID,Segatori Daniele12ORCID,Zanzarri Andrea12ORCID,Onori Luca12,Calderoni Claudia12ORCID,Benini Elisabetta12ORCID,Marano Giuseppe12,Massetti Marco12ORCID,Fiaschè Federica5,Di Segni Federica6,Janiri Delfina12,Simonetti Alessio12ORCID,Moccia Lorenzo12,Grisoni Flavia12ORCID,Ruggiero Sara12,Bartolucci Giovanni12ORCID,Biscosi Marco12ORCID,Ferrara Ottavia Marianna12ORCID,Bernardi Evelina12,Monacelli Leonardo12,Giannico Alessandro Michele12ORCID,De Berardis Domenico7ORCID,Battisti Giulia12,Ciliberto Michele12ORCID,Brisi Caterina12,Lisci Francesco Maria12ORCID,D’Onofrio Antonio Maria12ORCID,Restaino Antonio12ORCID,Di Benedetto Luca12,Anesini Maria Benedetta12ORCID,Boggio Gianluca12ORCID,Specogna Elettra12,Crupi Arianna12,De Chiara Emanuela12,Caroppo Emanuele8ORCID,Ieritano Valentina12,Monti Laura9,Chieffo Daniela Pia Rosaria910,Rinaldi Lucio12,Camardese Giovanni12,Cuomo Ilaria11,Brugnoli Roberto12,Kotzalidis Georgios D.12ORCID,Sani Gabriele12ORCID,Mazza Marianna12ORCID

Affiliation:

1. Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168 Rome, Italy

2. Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy

3. Department of Psychiatry, Università Vita-Salute San Raffaele, 20132 Milan, Italy

4. UOC Psichiatria, Sant’Andrea University Hospital, Università La Sapienza of Rome, Via di Grottarossa 1035-1039, 00189 Rome, Italy

5. ASL RM1, Presidio Ospedaliero San Filippo Neri, Servizio Psichiatrico di Diagnosi e Cura, Via Giovanni Martinotti, 20, 00135 Rome, Italy

6. ASL Roma 2, Dipartimento di Salute Mentale, Servizio Per Le Dipendenze Patologiche Distretto 7, Via dei Sestili 7, 00174 Rome, Italy

7. Department of Mental Health, ASL 4 Teramo, 64100 Teramo, Italy

8. Department of Mental Health, Local Health Authority Roma 2, 00159 Rome, Italy

9. Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy

10. Department Women Children and Public Health, Catholic University of Sacred Heart, 00168 Rome, Italy

11. ASL RM1, UOC SM Distretto XIII ASL Roma 1, CSM Via Boccea 271271, 00168 Rome, Italy

Abstract

Background/Objectives: Lithium taken during pregnancy was linked in the past with increased risk for foetal/newborn malformations, but clinicians believe that it is worse for newborn children not to treat the mothers’ underlying psychiatric illness. We set to review the available evidence of adverse foetal outcomes in women who received lithium treatment for some time during their pregnancy. Methods: We searched four databases and a register to seek papers reporting neonatal outcomes of women who took lithium during their pregnancy by using the appropriate terms. We adopted the PRISMA statement and used Delphi rounds among all the authors to assess eligibility and the Cochrane Risk-of-Bias tool to evaluate the RoB of the included studies. Results: We found 28 eligible studies, 10 of which met the criteria for inclusion in the meta-analysis. The studies regarded 1402 newborn babies and 2595 women exposed to lithium. Overall, the systematic review found slightly increased adverse pregnancy outcomes for women taking lithium for both the first trimester only and any time during pregnancy, while the meta-analysis found increased odds for cardiac or other malformations, preterm birth, and a large size for gestational age with lithium at any time during pregnancy. Conclusions: Women with BD planning a pregnancy should consider discontinuing lithium when euthymic; lithium use during the first trimester and at any time during pregnancy increases the odds for some adverse pregnancy outcomes. Once the pregnancy has started, there is no reason for discontinuing lithium; close foetal monitoring and regular blood lithium levels may obviate some disadvantages of lithium administration during pregnancy.

Publisher

MDPI AG

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