USMLE Forums banner

Lithium and pregnancy

9K views 10 replies 7 participants last post by  survivor 
#1 ·
Hi all, I have done my fair share of research and I havent found a concise answer about this and I would like to ask for everyone's help.

The thing is this.. Both MTB 3 and Kaplan Lecture notes say that in pregnancy you discontinue Lithium and if there is an acute manic episode during the first trimester you treat with ECT; and from the 2nd trimester onward you use Lamotrigine.

However I remember uworld stated that you dont discontinue the drug, you just divide the doses and decrease them a little bit + you do a cardiac ECHO at 14-18 weeks to screen for the famous Ebstein anomaly.
Here is the link from uworld: http://www.educus.com/Journals/SrchDet.aspx?pmid=18982835&AspxAutoDetectCookieSupport=1

So what would you answer on the exam? this topic is quite weird:eek:
 
#7 ·
Indeed...I know what you put.
The thing is....in kaplan step 3 qbank where it is stated that we should stop it, but they give a case where the patient is pretty much at the end of the first trimester and chronically well managed with lithium.

I did choose "continue lithium" (since it is already late, very late to care about the 1% of possiblity of an ebstein), and therefore, ...withdrawing the drug would be no longer convenient. ECT is not a happy thing to begin with, and should be used in particular cases like emergencies.

I did choose that option instead of withdraw the drug plus ECT because I read over there that if the patient was chronically on a drug and successfully, and if it is late enough... (as in kap example) then it would be worthless to stop the drug and perhaps innecesary. :notsure:

I already finished uworld qbank, fischer book and now I am in kaplan qbank.. that is why I feel bad because I am still doubting on this.
The day of my exam, september 2nd, I would mark ECT anyway :notsure:
 
#8 ·
I think in the begining you are suppose to stop it and do ECT if she needs it. Kaplan says the same thing and 2nd and 3rd trimester with lamotrigine. I have never heard of decreasing the dose. it also makes sense to stop it and not decrease the dose because lithium has a very narrow therapeutic index....
 
#9 ·
The damage hasn't 'already been done'. We can't reduce the risk of Ebstein's Anomaly, you're right, but by tapering Lithium down we decrease the risk of:
1- Cretinism
2- Transient Neuromuscular dysfunction
Both are problems associated with the use of Lithium in the 2nd and 3rd trimesters of pregnancy.
 
#11 ·
hehe now it is 2016 ..
I started my step 3 preparation and I am confused about this topic also.
what i know that we should continue lithium in pregnancy , it is considered 1st choice despite being category D but the risk is acceptable given the problem of mania. Although ECT is safe with the only problem being fetal arythmia but is not sufficient alone as monotherapy for mood stabilization.
I will keep her on lithium and do an echo on 14 weeks gestation..
 
This is an older thread, you may not receive a response, and could be reviving an old thread. Please consider creating a new thread.
Top