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    Is lithium in early pregnancy as dangerous as previously thought?

    A new study in The New England Journal of Medicine indicates that there may be less risk associated with using lithium in the first trimester than previously been thought.

    Researchers looked at 1,325,563 pregnancies among women who were enrolled in Medicaid and delivered a live-born infant between 2000 and 2010. They compared risk of cardiac malformation among babies who were exposed to lithium during the first trimester versus in those with no exposure to the drug. A secondary analysis compared infants who had been exposed to lamotrigine.

    Next: Trimester Zero

    Cardiac malformations were found in 15,251 of the 1,322,955 infants who were unexposed (1.15%); 27 of the 1945 infants who were exposed to lamotrigine (1.39%); and 16 of the 663 infants exposed to lithium (2.41%). When compared with unexposed infants, those who had been exposed to lithium had an adjusted risk ratio (aRR) for cardiac malformations of 1.65 (95% confidence interval [CI], 1.02 to 2.68). When looking at the dosage, the RR for more than 900 mg per day of the drug was 3.22 (95% CI, 1.47 to 7.02); 1.60 (95% CI, 0.67 to 3.80) for 601 to 900 mg; and 1.11 (95% CI, 0.46 to 2.64) for 600 mg or less. Prevalence of right ventricular outflow tract obstruction defects was 0.60% among infants with lithium exposure and 0.18% among infants with no exposure (aRR, 2.66; 95% CI, 1.00 to 7.06). Similar results were seen when infants exposed to lamotrigine were used as the reference group.

    Researchers concluded that while use of lithium during pregnancy is tied to increased risk of cardiac malformations, the magnitude of the issue is not as great as previously believed

    Judith M. Orvos, ELS
    Judith M. Orvos, ELS, is a a BELS-certified medical writer and editor and an editorial consultant for Contemporary OB/GYN.
    Miranda Hester
    Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

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