Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark; Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
School of Pharmacy, Aston University, Birmingham, United Kingdom; Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong.
School of Pharmacy, Sungkyunkwan University, Seoul, South Korea.
School of Pharmacy, Sungkyunkwan University, Seoul, South Korea.
Department of Chronic Diseases and Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand.
Department of Data and Analytics, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden.
National Drug and Alcohol Research Centre, University of New South Wales (UNSW) Sydney, Sydney, Australia; School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, MA, Boston, United States.
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, MA, Boston, United States.
Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany.
School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Data and Analytics, Finnish Institute for Health and Welfare, Helsinki, Finland; Teratology Information Service, Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong; Research Department of Practice and Policy, UCL (University College London) School of Pharmacy, London, United Kingdom; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS (National Health Service) Foundation Trust, London, United Kingdom.
Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong.
Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand.
Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark.
Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel; Department of Environmental Health, Harvard T.H. Chan School of Public Health, MA, Boston, United States.
Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany; Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany.
School of Pharmacy, Sungkyunkwan University, Seoul, South Korea.
National Drug and Alcohol Research Centre, University of New South Wales (UNSW) Sydney, Sydney, Australia.
School of Pharmacy, Aston University, Birmingham, United Kingdom; Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong; School of Pharmacy, Medical Sciences Division, Macau University of Science and Technology, Macau, China.
School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia; Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík.
Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
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.
American Medical Association (AMA), 2024. Vol. 7, no 12, article id e2451117