[Sex-specific lithium management and perinatal specificities]

Women require lower lithium doses than men and have an increased risk of renal and thyroid adverse effects. During pregnancy, lithium clearance progressively increases by 30 to 50 %, requiring frequent dose adjustments to maintain therapeutic serum concentrations between 0.6 and 1.0 mmol/l. Lithium is associated with a moderate increase in the risk of congenital malformations (odds ratio: 1.75-1.81), particularly cardiac malformations. Nevertheless, the absolute risk remains low. Close monitoring of serum concentrations is essential during pregnancy and the postpartum period, which is associated with a high risk of relapse. Breastfeeding while taking lithium remains controversial and requires individualized assessment.