Management of Lithium in Pregnancy and Lactation: An Individualized Approach

Bipolar disorder (BD) is a chronic illness that affects around 4% of the population, impacting women throughout their reproductive years. Times of hormonal change, such as peripartum, can be a particularly vulnerable period for individuals. There is a high risk of mood episodes during this time, and pharmacotherapy remains the primary treatment for individuals with BD. For many patients and clinicians, fears and misunderstandings around the use of lithium in pregnancy and lactation result in discontinuation of treatment or undertreatment. This review examines the data on lithium use in pregnancy and lactation, and focuses on optimizing management with an individualized approach.

Lithium is a reasonable treatment option throughout peripartum including during lactation, although dose adjustments and additional monitoring may be necessary. Patients with mood disorders who achieve stability on lithium and are planning for pregnancy can continue lithium and maintain emotional wellness, with an individualized approach to dosing and monitoring.