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. 2015 Mar 20;10(3):e0121024.
doi: 10.1371/journal.pone.0121024. eCollection 2015.

Lithium prescribing during pregnancy: a UK primary care database study

Rachel L McCrea  1 , Irwin Nazareth  1 , Stephen J W Evans  2 , David P J Osborn  3 , Vanessa Pinfold  4 , Phil J Cowen  5 , Irene Petersen  1
Affiliations

Lithium prescribing during pregnancy: a UK primary care database study

Rachel L McCrea et al. PLoS One. .

Abstract

Background: Women taking lithium must decide whether to continue the medication if they conceive or plan to conceive. Little is known about the extent of prescribing of lithium during pregnancy.

Aims: To determine: 1) the prevalence of lithium prescribing during pregnancy and 2) to assess whether pregnancy is associated with discontinuation of lithium.

Method: First, we identified women receiving any lithium prescriptions before and during pregnancy using The Health Improvement Network (THIN) primary care database. Subsequently, we used a Kaplan-Meier plot to compare time to last prescription in women prescribed lithium continuously three months before pregnancy and a comparison group of non-pregnant women. Finally, we described the characteristics of the women prescribed lithium in pregnancy.

Results: Very few women were prescribed lithium during pregnancy; out of 458,761 pregnancies, we identified 47 (0.01%) in which lithium was prescribed after the 6th week of pregnancy (when the pregnancy was likely to be known). In our study of discontinuation, we found pregnant women were more likely to stop lithium than those who were not pregnant. Of the 52 women who were being continuously prescribed lithium three months before pregnancy, only 17 (33%) continued receiving prescriptions beyond the 6th week of pregnancy. However, most of these 17 women continued treatment throughout pregnancy.

Conclusions: Pregnancy was strongly associated with discontinuation of lithium. Further evidence on the risks of lithium is needed so that women can weight these against the risk of a deterioration in maternal mental health.

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Conflict of interest statement

Competing Interests: The authors would like to confirm that Irene Petersen is PLOS ONE Editorial Board member. This does not alter their adherence to PLOS ONE Editorial policies and criteria. Likewise they would like to confirm that PJC is a member of an advisory board for Lundbeck. This does not alter their adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Discontinuation of lithium in pregnant and non-pregnant women.
See this image and copyright information in PMC

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