TY - JOUR
T1 - Lithium Use During Pregnancy in 14 Countries
AU - Wittström, Felix
AU - Cesta, Carolyn E.
AU - Bateman, Brian T.
AU - Bendix, Marie
AU - Bliddal, Mette
AU - Chan, Adrienne Y.L.
AU - Cho, Yongtai
AU - Choi, Eun Young
AU - Cohen, Jacqueline M.
AU - Donald, Sarah
AU - Gissler, Mika
AU - Havard, Alys
AU - Hernandez-Diaz, Sonia
AU - Huybrechts, Krista F.
AU - Kollhorst, Bianca
AU - Lai, Edward Chia Cheng
AU - Leinonen, Maarit K.
AU - Li, Brian M.H.
AU - Man, Kenneth K.C.
AU - Ng, Vanessa W.S.
AU - Parkin, Lianne
AU - Pazzagli, Laura
AU - Rasmussen, Lotte
AU - Rotem, Ran S.
AU - Schink, Tania
AU - Shin, Ju Young
AU - Tran, Duong T.
AU - Wong, Ian C.K.
AU - Zoega, Helga
AU - Reutfors, Johan
PY - 2024/12/2
Y1 - 2024/12/2
N2 - Importance: In pregnancy, the benefits of lithium treatment for relapse prevention in psychiatric conditions must be weighed against potential teratogenic effects. Currently, there is a paucity of information on how and when lithium is used by pregnant women. Objective: To examine lithium use in the perinatal period. Design, Setting, and Participants: This cohort study used individual-level data of pregnancies from January 1, 2000, to December 31, 2021, in Australia, Denmark, Finland, Germany, Hong Kong, Iceland, Israel, New Zealand, Norway, South Korea, Sweden, Taiwan, the UK, and 2 cohorts in the US. Analyses were performed from September 1 to November 30, 2023. Exposures: The prevalence of lithium use as the proportion of pregnancies with at least 1 prescription fill or prescription within 3 months before pregnancy until childbirth was estimated using a common protocol. Lithium use during pregnancy by trimester and in the 3 months before and after pregnancy was examined. Main Outcomes and Measures: Comparison of prevalence between the first and last 3-year periods of available data. Results: Among 21 659 454 pregnancies from all collaborating sites, the prevalence of lithium use ranged from 0.07 per 1000 pregnancies in Hong Kong to 1.56 per 1000 in the US publicly insured population. Lithium use increased per 1000 pregnancies in 10 populations (Australia [0.60 to 0.74], Denmark [0.09 to 0.51], Finland [0.10 to 0.29], Iceland [0.24 to 0.99], Israel [0.25 to 0.37], Norway [0.24 to 0.47], South Korea [0.30 to 0.44], Sweden [0.42 to 1.07], the UK [0.07 to 0.10], and Taiwan [0.15 to 0.19]), remained stable in 4 populations (Germany [0.17 to 0.16], Hong Kong [0.06 to 0.06], and the publicly [1.50 to 1.34] and commercially [0.38 to 0.36] insured US populations), and decreased in 1 population (New Zealand [0.54 to 0.39]). Use of lithium decreased with each trimester of pregnancy, while prevalence of postpartum use was similar to prepregnancy levels. The proportion of lithium use in the second trimester compared with the prepregnancy period ranged from 2% in South Korea to 80% in Denmark. Conclusions and Relevance: Prevalence of lithium use in pregnant women over the past 2 decades varied markedly between populations. Patterns of use before, during, and after pregnancy suggest that many women discontinued lithium use during pregnancy and reinitiated treatment after childbirth, with large variations between countries. These findings underscore the need for internationally harmonized guidelines, specifically for psychiatric conditions among pregnant women that may benefit from lithium treatment.
AB - Importance: In pregnancy, the benefits of lithium treatment for relapse prevention in psychiatric conditions must be weighed against potential teratogenic effects. Currently, there is a paucity of information on how and when lithium is used by pregnant women. Objective: To examine lithium use in the perinatal period. Design, Setting, and Participants: This cohort study used individual-level data of pregnancies from January 1, 2000, to December 31, 2021, in Australia, Denmark, Finland, Germany, Hong Kong, Iceland, Israel, New Zealand, Norway, South Korea, Sweden, Taiwan, the UK, and 2 cohorts in the US. Analyses were performed from September 1 to November 30, 2023. Exposures: The prevalence of lithium use as the proportion of pregnancies with at least 1 prescription fill or prescription within 3 months before pregnancy until childbirth was estimated using a common protocol. Lithium use during pregnancy by trimester and in the 3 months before and after pregnancy was examined. Main Outcomes and Measures: Comparison of prevalence between the first and last 3-year periods of available data. Results: Among 21 659 454 pregnancies from all collaborating sites, the prevalence of lithium use ranged from 0.07 per 1000 pregnancies in Hong Kong to 1.56 per 1000 in the US publicly insured population. Lithium use increased per 1000 pregnancies in 10 populations (Australia [0.60 to 0.74], Denmark [0.09 to 0.51], Finland [0.10 to 0.29], Iceland [0.24 to 0.99], Israel [0.25 to 0.37], Norway [0.24 to 0.47], South Korea [0.30 to 0.44], Sweden [0.42 to 1.07], the UK [0.07 to 0.10], and Taiwan [0.15 to 0.19]), remained stable in 4 populations (Germany [0.17 to 0.16], Hong Kong [0.06 to 0.06], and the publicly [1.50 to 1.34] and commercially [0.38 to 0.36] insured US populations), and decreased in 1 population (New Zealand [0.54 to 0.39]). Use of lithium decreased with each trimester of pregnancy, while prevalence of postpartum use was similar to prepregnancy levels. The proportion of lithium use in the second trimester compared with the prepregnancy period ranged from 2% in South Korea to 80% in Denmark. Conclusions and Relevance: Prevalence of lithium use in pregnant women over the past 2 decades varied markedly between populations. Patterns of use before, during, and after pregnancy suggest that many women discontinued lithium use during pregnancy and reinitiated treatment after childbirth, with large variations between countries. These findings underscore the need for internationally harmonized guidelines, specifically for psychiatric conditions among pregnant women that may benefit from lithium treatment.
UR - http://www.scopus.com/inward/record.url?scp=85212991947&partnerID=8YFLogxK
U2 - 10.1001/jamanetworkopen.2024.51117
DO - 10.1001/jamanetworkopen.2024.51117
M3 - Article
C2 - 39680408
AN - SCOPUS:85212991947
SN - 2574-3805
VL - 7
SP - e2451117
JO - JAMA network open
JF - JAMA network open
IS - 12
ER -