Cargando…

Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study

BACKGROUND: Lithium is prescribed during pregnancy, but there is limited information about pregnancy and neonatal outcomes following in utero exposure. Thus, this study aimed to investigate the associations between lithium use and adverse pregnancy and neonatal outcomes. METHODS: This population-bas...

Descripción completa

Detalles Bibliográficos
Autores principales: Hastie, Roxanne, Tong, Stephen, Hiscock, Richard, Lindquist, Anthea, Lindström, Linda, Wikström, Anna-Karin, Sundström-Poromaa, Inger
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8641220/
https://www.ncbi.nlm.nih.gov/pubmed/34856987
http://dx.doi.org/10.1186/s12916-021-02170-7
_version_ 1784609462883975168
author Hastie, Roxanne
Tong, Stephen
Hiscock, Richard
Lindquist, Anthea
Lindström, Linda
Wikström, Anna-Karin
Sundström-Poromaa, Inger
author_facet Hastie, Roxanne
Tong, Stephen
Hiscock, Richard
Lindquist, Anthea
Lindström, Linda
Wikström, Anna-Karin
Sundström-Poromaa, Inger
author_sort Hastie, Roxanne
collection PubMed
description BACKGROUND: Lithium is prescribed during pregnancy, but there is limited information about pregnancy and neonatal outcomes following in utero exposure. Thus, this study aimed to investigate the associations between lithium use and adverse pregnancy and neonatal outcomes. METHODS: This population-based cohort study examined associations between maternal lithium use and major adverse pregnancy and neonatal outcomes via inverse probability weighted propensity score regression models. RESULTS: Of 854,017 women included in this study, 434 (0.05%) used lithium during pregnancy. Among pre-specified primary outcomes, lithium use during pregnancy was associated with an increased risk of spontaneous preterm birth (8.7% vs 3.0%; adjusted relative risk [aRR] 2.64 95% CI 1.82, 3.82) and birth of a large for gestational age infant (9.0% vs 3.5%; aRR 2.64 95% CI 1.91, 3.66), but not preeclampsia nor birth of a small for gestational age infant. Among secondary outcomes, lithium use was associated with an increased risk of cardiac malformations (2.1% vs 0.8%; aRR 3.17 95% CI 1.64, 6.13). In an analysis restricted to pregnant women with a diagnosed psychiatric illness (n=9552), associations remained between lithium and spontaneous preterm birth, birth of a large for gestational age infant, and cardiovascular malformations; and a positive association with neonatal hypoglycaemia was also found. These associations were also apparent in a further analysis comparing women who continued lithium treatment during pregnancy to those who discontinued prior to pregnancy. CONCLUSIONS: Lithium use during pregnancy is associated with an increased risk of spontaneous preterm birth and other adverse neonatal outcomes. These potential risks must be balanced against the important benefit of treatment and should be used to guide shared decision-making. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12916-021-02170-7.
format Online
Article
Text
id pubmed-8641220
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-86412202021-12-06 Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study Hastie, Roxanne Tong, Stephen Hiscock, Richard Lindquist, Anthea Lindström, Linda Wikström, Anna-Karin Sundström-Poromaa, Inger BMC Med Research Article BACKGROUND: Lithium is prescribed during pregnancy, but there is limited information about pregnancy and neonatal outcomes following in utero exposure. Thus, this study aimed to investigate the associations between lithium use and adverse pregnancy and neonatal outcomes. METHODS: This population-based cohort study examined associations between maternal lithium use and major adverse pregnancy and neonatal outcomes via inverse probability weighted propensity score regression models. RESULTS: Of 854,017 women included in this study, 434 (0.05%) used lithium during pregnancy. Among pre-specified primary outcomes, lithium use during pregnancy was associated with an increased risk of spontaneous preterm birth (8.7% vs 3.0%; adjusted relative risk [aRR] 2.64 95% CI 1.82, 3.82) and birth of a large for gestational age infant (9.0% vs 3.5%; aRR 2.64 95% CI 1.91, 3.66), but not preeclampsia nor birth of a small for gestational age infant. Among secondary outcomes, lithium use was associated with an increased risk of cardiac malformations (2.1% vs 0.8%; aRR 3.17 95% CI 1.64, 6.13). In an analysis restricted to pregnant women with a diagnosed psychiatric illness (n=9552), associations remained between lithium and spontaneous preterm birth, birth of a large for gestational age infant, and cardiovascular malformations; and a positive association with neonatal hypoglycaemia was also found. These associations were also apparent in a further analysis comparing women who continued lithium treatment during pregnancy to those who discontinued prior to pregnancy. CONCLUSIONS: Lithium use during pregnancy is associated with an increased risk of spontaneous preterm birth and other adverse neonatal outcomes. These potential risks must be balanced against the important benefit of treatment and should be used to guide shared decision-making. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12916-021-02170-7. BioMed Central 2021-12-02 /pmc/articles/PMC8641220/ /pubmed/34856987 http://dx.doi.org/10.1186/s12916-021-02170-7 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Hastie, Roxanne
Tong, Stephen
Hiscock, Richard
Lindquist, Anthea
Lindström, Linda
Wikström, Anna-Karin
Sundström-Poromaa, Inger
Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study
title Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study
title_full Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study
title_fullStr Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study
title_full_unstemmed Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study
title_short Maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a Swedish population-based cohort study
title_sort maternal lithium use and the risk of adverse pregnancy and neonatal outcomes: a swedish population-based cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8641220/
https://www.ncbi.nlm.nih.gov/pubmed/34856987
http://dx.doi.org/10.1186/s12916-021-02170-7
work_keys_str_mv AT hastieroxanne maternallithiumuseandtheriskofadversepregnancyandneonataloutcomesaswedishpopulationbasedcohortstudy
AT tongstephen maternallithiumuseandtheriskofadversepregnancyandneonataloutcomesaswedishpopulationbasedcohortstudy
AT hiscockrichard maternallithiumuseandtheriskofadversepregnancyandneonataloutcomesaswedishpopulationbasedcohortstudy
AT lindquistanthea maternallithiumuseandtheriskofadversepregnancyandneonataloutcomesaswedishpopulationbasedcohortstudy
AT lindstromlinda maternallithiumuseandtheriskofadversepregnancyandneonataloutcomesaswedishpopulationbasedcohortstudy
AT wikstromannakarin maternallithiumuseandtheriskofadversepregnancyandneonataloutcomesaswedishpopulationbasedcohortstudy
AT sundstromporomaainger maternallithiumuseandtheriskofadversepregnancyandneonataloutcomesaswedishpopulationbasedcohortstudy