Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study

Abstract Background Lithium is prescribed during pregnancy, but there is limited information about pregnancy and neonatal outcomes following in utero exposure. Thus, this study aimed to investigate the associations between lithium use and adverse pregnancy and neonatal outcomes. Methods This populat...

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Autores principales:	Roxanne Hastie, Stephen Tong, Richard Hiscock, Anthea Lindquist, Linda Lindström, Anna-Karin Wikström, Inger Sundström-Poromaa
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Lithium Pregnancy Preterm birth Bipolar Perinatal psychiatry Medicine R
Acceso en línea:	https://doaj.org/article/247023f1f43848b0b4e11cd9cb6ff95a
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spelling	oai:doaj.org-article:247023f1f43848b0b4e11cd9cb6ff95a2021-12-05T12:11:15ZMaternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study10.1186/s12916-021-02170-71741-7015https://doaj.org/article/247023f1f43848b0b4e11cd9cb6ff95a2021-12-01T00:00:00Zhttps://doi.org/10.1186/s12916-021-02170-7https://doaj.org/toc/1741-7015Abstract Background Lithium is prescribed during pregnancy, but there is limited information about pregnancy and neonatal outcomes following in utero exposure. Thus, this study aimed to investigate the associations between lithium use and adverse pregnancy and neonatal outcomes. Methods This population-based cohort study examined associations between maternal lithium use and major adverse pregnancy and neonatal outcomes via inverse probability weighted propensity score regression models. Results Of 854,017 women included in this study, 434 (0.05%) used lithium during pregnancy. Among pre-specified primary outcomes, lithium use during pregnancy was associated with an increased risk of spontaneous preterm birth (8.7% vs 3.0%; adjusted relative risk [aRR] 2.64 95% CI 1.82, 3.82) and birth of a large for gestational age infant (9.0% vs 3.5%; aRR 2.64 95% CI 1.91, 3.66), but not preeclampsia nor birth of a small for gestational age infant. Among secondary outcomes, lithium use was associated with an increased risk of cardiac malformations (2.1% vs 0.8%; aRR 3.17 95% CI 1.64, 6.13). In an analysis restricted to pregnant women with a diagnosed psychiatric illness (n=9552), associations remained between lithium and spontaneous preterm birth, birth of a large for gestational age infant, and cardiovascular malformations; and a positive association with neonatal hypoglycaemia was also found. These associations were also apparent in a further analysis comparing women who continued lithium treatment during pregnancy to those who discontinued prior to pregnancy. Conclusions Lithium use during pregnancy is associated with an increased risk of spontaneous preterm birth and other adverse neonatal outcomes. These potential risks must be balanced against the important benefit of treatment and should be used to guide shared decision-making.Roxanne HastieStephen TongRichard HiscockAnthea LindquistLinda LindströmAnna-Karin WikströmInger Sundström-PoromaaBMCarticleLithiumPregnancyPreterm birthBipolarPerinatal psychiatryMedicineRENBMC Medicine, Vol 19, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Lithium Pregnancy Preterm birth Bipolar Perinatal psychiatry Medicine R
spellingShingle	Lithium Pregnancy Preterm birth Bipolar Perinatal psychiatry Medicine R Roxanne Hastie Stephen Tong Richard Hiscock Anthea Lindquist Linda Lindström Anna-Karin Wikström Inger Sundström-Poromaa Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study
description	Abstract Background Lithium is prescribed during pregnancy, but there is limited information about pregnancy and neonatal outcomes following in utero exposure. Thus, this study aimed to investigate the associations between lithium use and adverse pregnancy and neonatal outcomes. Methods This population-based cohort study examined associations between maternal lithium use and major adverse pregnancy and neonatal outcomes via inverse probability weighted propensity score regression models. Results Of 854,017 women included in this study, 434 (0.05%) used lithium during pregnancy. Among pre-specified primary outcomes, lithium use during pregnancy was associated with an increased risk of spontaneous preterm birth (8.7% vs 3.0%; adjusted relative risk [aRR] 2.64 95% CI 1.82, 3.82) and birth of a large for gestational age infant (9.0% vs 3.5%; aRR 2.64 95% CI 1.91, 3.66), but not preeclampsia nor birth of a small for gestational age infant. Among secondary outcomes, lithium use was associated with an increased risk of cardiac malformations (2.1% vs 0.8%; aRR 3.17 95% CI 1.64, 6.13). In an analysis restricted to pregnant women with a diagnosed psychiatric illness (n=9552), associations remained between lithium and spontaneous preterm birth, birth of a large for gestational age infant, and cardiovascular malformations; and a positive association with neonatal hypoglycaemia was also found. These associations were also apparent in a further analysis comparing women who continued lithium treatment during pregnancy to those who discontinued prior to pregnancy. Conclusions Lithium use during pregnancy is associated with an increased risk of spontaneous preterm birth and other adverse neonatal outcomes. These potential risks must be balanced against the important benefit of treatment and should be used to guide shared decision-making.
format	article
author	Roxanne Hastie Stephen Tong Richard Hiscock Anthea Lindquist Linda Lindström Anna-Karin Wikström Inger Sundström-Poromaa
author_facet	Roxanne Hastie Stephen Tong Richard Hiscock Anthea Lindquist Linda Lindström Anna-Karin Wikström Inger Sundström-Poromaa
author_sort	Roxanne Hastie
title	Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study
title_short	Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study
title_full	Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study
title_fullStr	Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study
title_full_unstemmed	Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study
title_sort	maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a swedish population-based cohort study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/247023f1f43848b0b4e11cd9cb6ff95a
work_keys_str_mv	AT roxannehastie maternallithiumuseandtheriskofadversepregnancyandneonataloutcomesaswedishpopulationbasedcohortstudy AT stephentong maternallithiumuseandtheriskofadversepregnancyandneonataloutcomesaswedishpopulationbasedcohortstudy AT richardhiscock maternallithiumuseandtheriskofadversepregnancyandneonataloutcomesaswedishpopulationbasedcohortstudy AT anthealindquist maternallithiumuseandtheriskofadversepregnancyandneonataloutcomesaswedishpopulationbasedcohortstudy AT lindalindstrom maternallithiumuseandtheriskofadversepregnancyandneonataloutcomesaswedishpopulationbasedcohortstudy AT annakarinwikstrom maternallithiumuseandtheriskofadversepregnancyandneonataloutcomesaswedishpopulationbasedcohortstudy AT ingersundstromporomaa maternallithiumuseandtheriskofadversepregnancyandneonataloutcomesaswedishpopulationbasedcohortstudy
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Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study

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