Lithium During Pregnancy & Breastfeeding

by on May 9, 2012

Lithium is a capsule medication that is most often used to treat and prevent mania or bipolar disorder. The FDA categorizes lithium as a Pregnancy Category D medication, meaning that it should not be taken during pregnancy or while breastfeeding.

Lithium During Pregnancy

Lithium should not be taken during pregnancy. The FDA has issued a warning that says the use of lithium as early as the first trimester can lead to a number of congenital fetal defects. Cardiac defects are most common in fetuses exposed to lithium during pregnancy, and neonates whose mothers take lithium during pregnancy can suffer from lithium toxicity upon birth.

A fetus does not have a fully developed liver or kidneys, and thus might not be able to excrete toxins from lithium exposure in time to avoid suffering damage to its organs. Because of these dangers, you should tell your doctor if you become pregnant while taking lithium. Lithium use can be halted early on with a minimum risk of side effects.

Lithium and Breastfeeding

The FDA and the American Academy of Pediatrics (AAP) has issued a recommendation against lithium use while breastfeeding.

Lithium can be excreted into breast milk, and can give a nursing infant up to half a dose. This level of lithium can cause cardiac abnormalities in infants, especially if they become dehydrated.

While long term growth or developmental effects are rare in infants who are exposed to lithium through breast milk, several reports of increased thyroid stimulating hormones and blood urea nitrogen have been reported. Nursing mothers suffering from bipolar disorder or similar illnesses should contact their doctor regarding possible alternatives to lithium while breastfeeding.

Side Effects in Pregnant or Breastfeeding Patients

The damage done by lithium to pregnant patients is not to the mother but rather to the fetus. Cardiac defects are most common among infants exposed to lithium during gestation, with Ebstein’s anomaly most often being associated with exposure. Fetuses that are exposed to lithium late in pregnancy might suffer from cyanosis or electrocardiogram abnormalities upon birth.

For women who discontinue lithium usage, the recurrence of bipolar disorder or other mental illness is not significantly different from other pregnant women, although this rate does sharply increase postpartum. Lithium should only be taken during pregnancy when a doctor determines that the benefits outweigh the risks.

Only in very specific situations will a doctor suggest the continued use of lithium while a mother is pregnant or breastfeeding. In general, lithium should not be taken during this period, as it can be harmful to the fetus or infant. Mothers discontinuing lithium use often have few side effects during pregnancy, but should be aware of an increased risk of postpartum symptoms and should contact their doctor regarding alternatives to lithium while breastfeeding.