From the Research
Lithium levels should be checked monthly during the first and second trimesters of pregnancy, then weekly during the third trimester, as recommended by the most recent and highest quality study 1. This approach is crucial to balance the risks and benefits of lithium treatment during pregnancy, considering the potential for congenital anomalies and cardiac malformations associated with lithium exposure 2, 1. The target serum lithium levels during pregnancy should be maintained at the lower end of the therapeutic range (0.6-0.8 mEq/L) to minimize fetal exposure while still providing therapeutic benefit, as suggested by the systematic review and meta-analysis 1. Some key points to consider:
- Dosage adjustments are frequently needed during pregnancy due to physiological changes that can affect lithium levels 3, 1.
- Close monitoring is essential because lithium has a narrow therapeutic window, and both insufficient treatment and toxicity pose risks 3, 1.
- Thyroid function and renal function should be assessed at least once each trimester, as lithium can affect both systems 3.
- Coordination between psychiatric care, obstetrics, and pediatrics is important to ensure optimal management throughout pregnancy and the postpartum period 3, 1.