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It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups:
A = Studies show no risk, so harm to the unborn child appears only a remote possibility
B = Animal and human studies indicate a lack of risk but are not fully conclusive
C = Animal studies indicate a risk but there is no safety data in humans
D = a definite risk exists but the benefit of the drug may outweigh the risk in some people
X = the risk outweighs any possible benefit
Lithium is classified as "D". There is much controversy about lithium in pregnancy. Early data from Scandinavia indicated a problem, but recent studies have indicated that the risk of problems is only slightly higher than in women not taking lithium. The other things to consider are that:
- if you have become pregnant unexpectedly, the risk of relapsing if you stop lithium suddenly is very high (as high as 50%)
- by the time you realise you're pregnant, the potential effect would already have happened so it'stoo late to stop.
The major risk with lithium in pregnancy is something called Ebstein's anomaly, a rare heart defect in the child. The chance of this happening without lithium is about 1 in 20,000 children, and this rises to about 1 in 1000 with lithium (i.e. 20 times higher, but still rare). This heart problem can be detected so you should seek personal advice from your GP, who will arrange for specialist screening to be carried out. Regular blood monitoring will be important as you get closer to your due date as lithium levels may rise towards the end of pregnancy. You should, however, still seek, who may then if necessary seek further specialist advice.
One piece of good news is that one study was able to show that lithium did not appear to have an effect on physical or mental development over the first 5-10 years of the child's life if the mum took lithium throughout pregnancy.