Lithium exposure during pregnancy increases fetal growth

Journal of Psychopharmacology, vol. 35, pp. 178–183

Abstract

Background: Lithium is an effective treatment in pregnancy and postpartum for the prevention of relapse in bipolar disorder, but there is a lack of knowledge about the potential adverse impact on fetal development. Aims: To investigate the impact of lithium exposure on early fetal growth. Methods: In this retrospective observational cohort study, we included all singleton pregnancies of women using lithium and referred for advanced fetal ultrasound scanning between 1994 and 2018 to the University Medical Centers in Leiden and Rotterdam, the Netherlands ( n=119). The Generation R study, a population-based cohort, served as a non-exposed control population from the same geographic region ( n=8184). Fetal head circumference, abdominal circumference, femur length, and transcerebellar diameter were measured by ultrasound at 18–22 weeks of gestation. Results: Lithium use during pregnancy was associated with an average increase in head circumference of 1.77 mm (95% confidence interval: 0.53, 3.01), in abdominal circumference of 5.54 mm (95% confidence interval: 3.95, 7.12) and in femur length of 0.59 mm (95% confidence interval: 0.22, 0.96) at 18–22 weeks gestation. Furthermore, lithium use during pregnancy was associated with an average increase in birth weight of 142.43 grams (95% confidence interval: 58.01, 226.89), whereas it was associated with an average decrease of 1.41 weeks in gestational duration (95% confidence interval: −1.78, −1.05). Conclusions: Lithium use during pregnancy was associated with increased fetal growth parameters at 18–22 weeks gestational age and increased birth weight. Further research is needed to evaluate both short- and long-term implications, as well as the mechanisms driving this difference in growth.

Authors 12

1. Eline M. P. Poels corresponding

   Erasmus MC

   Affiliation as printed

   Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands

2. Karin Sterrenburg

   Erasmus MC · Erasmus University Rotterdam

   Affiliation as printed

   Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands

3. André I. Wierdsma

   Erasmus MC

   Affiliation as printed

   Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands

4. Richard Wesseloo

   Erasmus MC · GGZ Delfland

   Affiliation as printed

   Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands

   Department of Psychiatry, GGZ Delfland, Delft, The Netherlands

5. Annemerle Beerthuizen

   Erasmus MC

   Affiliation as printed

   Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands

6. Laura van Dijke Aachen Department of Obstetrics, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands

7. Condon Lau

   City University of Hong Kong

   Affiliation as printed

   Department of Physics, City University of Hong Kong, Hong Kong SAR, China

8. Witte J.G. Hoogendijk

   Erasmus MC

   Affiliation as printed

   Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands

9. Hanan El Marroun

   Erasmus MC · Erasmus University Rotterdam

   Affiliation as printed

   Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, The Netherlands

   Department of Pediatrics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands

   Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioral Sciences, Erasmus University, Rotterdam, The Netherlands

10. Inge L. van Kamp Aachen Department of Obstetrics, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands

11. Hilmar H. Bijma

    Erasmus MC · Erasmus University Rotterdam

    Affiliation as printed

    Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands

12. Veerle Bergink

    Erasmus MC · Icahn School of Medicine at Mount Sinai

    Affiliation as printed

    Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, United States of America

    Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands

    Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States of America