Mood stabilizers in pregnancy: a systematic review

To undertake a systematic review of the effects of exposure to mood stabilizer medication in pregnancy, evaluating teratogenicity and other outcomes for mother and child. This was one of three concurrent systematic reviews of psychotropic medication exposure in pregnancy.

A systematic search was carried out of electronic databases, reference books and other sources for original research studies which examined the effects of commonly used mood stabilizers (sodium valproate, carbamazepine, lamotrigine and lithium carbonate) on pregnancy outcomes. These included malformations, pregnancy complications, neonatal complications and longer term developmental outcomes for children exposed.

All mood stabilizers were found to be associated with a risk of malformation and perinatal complications. Studies which examined longer term neurodevelopmental outcomes found poorer outcomes for those children exposed to sodium valproate or polytherapy in pregnancy than for other individual AEDs. The data available for longer term child outcomes with lithium exposure is too limited to draw any conclusions.

This review found that exposure in pregnancy to all four commonly used mood stabilizers may be teratogenic, and is associated with increased rates of pregnancy and neonatal complications. There was also more limited information that sodium valproate may be associated with poorer longer term child developmental outcomes. These findings must be balanced with the risk of relapse and poor pregnancy and child outcomes with untreated maternal bipolar disorder. The information obtained from these reviews of psychotropic medications will assist clinicians in managing women with mental illness in pregnancy.