Lithium exposure during pregnancy: outcomes for women who attended a specialist antenatal clinic

被引:13
|
作者
Frayne, Jacqueline [1 ,2 ]
Thinh Nguyen [3 ,4 ]
Mok, Tabitha [5 ]
Hauck, Yvonne [6 ,7 ]
Liira, Helena [2 ]
机构
[1] Women & Newborn Hlth Serv, Dept Obstet & Gynaecol, Subiaco, WA, Australia
[2] Univ Western Australia, Div Gen Practice, Sch Med, Nedlands, WA, Australia
[3] Univ Western Australia, Div Psychiat, Sch Med, Nedlands, WA, Australia
[4] Peel & Rockingham Kwinana Mental Hlth Serv, Rockingham, WA, Australia
[5] Women & Newborn Hlth Serv, Dept Psychol Med, Subiaco, WA, Australia
[6] Women & Newborn Hlth Serv, Dept Nursing & Midwifery Educ, Subiaco, WA, Australia
[7] Curtin Univ, Sch Nursing Midwifery & Paramed, Perth, WA, Australia
关键词
Lithium; mood disorders; pregnancy; obstetric; neonatal outcomes; SEVERE MENTAL-ILLNESS; BIPOLAR DISORDER; NEONATAL OUTCOMES; MANAGEMENT; TOXICITY; RISK;
D O I
10.1080/0167482X.2017.1337743
中图分类号
B849 [应用心理学];
学科分类号
040203 ;
摘要
Introduction: Lithium treatment in pregnancy represents a significant dilemma for women and treating health professionals alike. The complexity of risk-benefit analysis is impacted by limited information.Methods: A cohort study of 33 women with severe mental illness, who were prescribed lithium at any time during the pregnancy, and gave birth between December 2007 and January 2015 at a specialist antenatal clinic in Western Australia. A descriptive comparison for women who continued lithium throughout pregnancy, and those who ceased on discovery of pregnancy was undertaken examining demographic, obstetric, neonatal and psychiatric variables.Results: Women who were prescribed lithium, irrespective of whether they continued or discontinued the medication represented a high risk group obstetrically, with high rates of smoking overall (33%) medical comorbidities (54%) and antenatal complications (88%). Preconception counseling occurred in 33% of the cohort but increased the likelihood of continuing lithium in pregnancy (p=.007). Compared to those who ceased lithium, women who remained on lithium through the pregnancy had increased rates of fetal ultrasound abnormalities such as abdominal circumference >90th % (p=.005). Psychiatric relapses through the antenatal and immediate postpartum period appeared to be due to a combination of factors.Discussion: Pregnant women with severe mood disorders treated with lithium are a vulnerable, high-risk obstetric population who would benefit from preconception counseling, regular antenatal care in a tertiary center, delivery with neonatal pediatric support and experienced psychiatric management.
引用
收藏
页码:211 / 219
页数:9
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