Use of lithium in pregnancy & breastfeeding

• Ideally avoid in pregnancy as lithium carries a known risk of teratogenic effects.
• Discuss risks and benefits in all women of childbearing potential considering lithium treatment.
• The discussion should include contraceptive advice.
• Document this discussion and subsequent consent.
• 'BUMPS' website should be used to reinforce verbal information

If a woman taking lithium becomes pregnant take the following actions

• Confirm the pregnancy as early as possible.
• Seek advice on management from the Peri-natal service.
• If pregnancy is confirmed in the first trimester and the woman is stable, consider stopping lithium gradually over 4 weeks and inform the woman that this may not remove the risk of cardiac defects in the foetus.
• Consider offering an antipsychotic as prophylactic medication.
• Offer appropriate screening and counselling about the continuation of pregnancy, the need for additional monitoring and the risk to the foetus of remaining on lithium.
• Record details of all advice given and the woman's consent to treatment.

If lithium treatment is to continue:

• Check lithium levels every 4 weeks
• Then weekly from the 36^th week
• Then less than 24 hours after child birth
• The dose should be adjusted to keep levels within the therapeutic range
• The newborn baby should have a full paediatric assessment and social and medical help should be provided for the mother and child

More information on the use of lithium in pregnancy is available in appendix 3 of the attached lithium standards

Women on lithium who wish to breastfeed should:

• Be given advice on the risks and benefits of breastfeeding.
• Be advised not to if taking lithium and an alternative prophylactic agent should be offered.