Department of Mental Health ASL Salerno, Mental Health Center, Salerno, Italy.
Expert Opin Drug Saf. 2012 May;11(3):425-37. doi: 10.1517/14740338.2012.670419. Epub 2012 Mar 9.
Untreated bipolar disorder during pregnancy leads to detrimental repercussions on the mother-infant pair's health. Despite different drugs having been proposed as mood stabilizers, lithium remains the first-choice agent for preventing mood changes.
Analyzing up-to-date information on the reproductive safety of lithium and providing practice guidelines to optimize its use during pregnancy.
Findings from prospective and case-control studies confirm an increased, specific risk of Ebstein's anomaly (4.45-7.6/1000 live births), although lower than that previously reported. A potential increase in the risk of neural tube defects should also be taken into consideration. Moreover, several perinatal complications may occur, and even in the presence of relatively low infant serum levels, in the case of drug exposure during late pregnancy. Despite such concerns, lithium should still be considered the first-choice agent for treating bipolar disorder in pregnancy. Indeed, the U.S. FDA recently issued a new warning regarding the reproductive safety of antipsychotics. Moreover, the risk of fetal valproate/carbamazepine syndrome (and the confirmed neurodevelopmental teratogenicity of valproate) contraindicates the use of both medications, whereas the use of lamotrigine is limited by efficacy concerns. However, women who need lithium treatment during pregnancy should be carefully monitored: a strict gynecologic and psychiatric surveillance and, probably, preconception folate supplementation is highly advisable. Moreover, delivery should be programmed in Neonatal Intensive Care Units to ensure optimal management of potential iatrogenic perinatal complications.
未经治疗的妊娠期双相情感障碍会对母婴健康产生不利影响。尽管已有不同的药物被提议作为心境稳定剂，但锂仍是预防情绪变化的首选药物。
分析锂的生殖安全性的最新信息，并提供实践指南以优化其在怀孕期间的使用。
前瞻性和病例对照研究的结果证实了一种特定的埃布斯坦畸形（4.45-7.6/1000 活产儿）风险增加，尽管低于先前报告的风险。还应考虑到神经管缺陷风险的潜在增加。此外，可能会发生多种围产期并发症，即使在药物暴露于妊娠晚期时婴儿血清水平相对较低的情况下也是如此。尽管存在这些担忧，但在怀孕期间仍应考虑锂作为治疗双相情感障碍的首选药物。事实上，美国食品和药物管理局最近发布了关于抗精神病药物生殖安全性的新警告。此外，胎儿丙戊酸/卡马西平综合征（以及丙戊酸已证实的神经发育致畸性）的风险排除了这两种药物的使用，而拉莫三嗪的使用受到疗效的限制。然而，需要在怀孕期间接受锂治疗的女性应接受仔细监测：严格的妇科和精神科监测，可能还需要在受孕前补充叶酸。此外，应在新生儿重症监护病房计划分娩，以确保对潜在的医源性围产期并发症进行最佳管理。
