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Lithium prescribing during pregnancy: a UK primary care database study.

Rachel L McCrea¹, Irwin Nazareth¹, Stephen J W Evans²

¹University College London, Department of Primary Care and Population Health, London, United Kingdom.

|March 21, 2015

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Lithium prescribing during pregnancy is rare. Pregnant women are significantly more likely to discontinue lithium treatment compared to non-pregnant individuals.

Area of Science:

Perinatal mental health
Pharmacovigilance in pregnancy
Reproductive health

Background:

Lithium is a common mood stabilizer, but its use during pregnancy presents a dilemma for women.
Limited data exists on the prevalence of lithium prescriptions during pregnancy.

Purpose of the Study:

To determine the prevalence of lithium prescribing during pregnancy.
To assess the association between pregnancy and lithium discontinuation.

Main Methods:

Utilized The Health Improvement Network (THIN) primary care database to identify women with lithium prescriptions.
Employed Kaplan-Meier plots to compare lithium discontinuation rates between pregnant and non-pregnant women.
Described characteristics of women prescribed lithium during pregnancy.

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Main Results:

Lithium was prescribed in only 0.01% of pregnancies (47 out of 458,761) after the 6th week.
Pregnant women were more likely to discontinue lithium than non-pregnant women.
Of women on continuous lithium therapy before pregnancy, only 33% continued prescriptions past the 6th week, though most continued throughout gestation.

Conclusions:

Pregnancy is strongly associated with lithium discontinuation.
Further research is needed on lithium's risks to help women balance medication benefits against maternal mental health risks.