The Use of Lithium and Management of Women With Bipolar Disorder During Pregnancy and Lactation

The introduction of lithium salts almost a century ago and the subsequent approval of lithium carbonatefor the treatment of patients with bipolar disorder represent one of the cornerstones of modernpsychopharmacology. The onset of bipolar disorder in women often occurs during the childbearingyears, which complicates the treatment decisions secondary to the possibility of conception while takingmedication. The establishment of the lithium registry for fetal teratogenesis in the late 1960s usheredin a heightened level of concern for the use of lithium during the reproductive years; although, inthe years to come, it has become apparent that alternative pharmacologic treatments for bipolar disordermay exceed the teratogenic risk of lithium monotherapy. In this paper, the available data on the useof antimanic medications during pregnancy and lactation are reviewed with an emphasis on providinga realistic risk/benefit assessment for medication selection and management of these patients. Treatmentstrategies are discussed for (1) women who are contemplating pregnancy (2) women who inadvertentlyconceive while taking medications (3) women who choose to become pregnant while takingmedication, and (4) women who intend to breastfeed while taking medications.