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dutchie1

lithium pregnancy

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6. The lady with BPAD who are stable on lithium for three years and want to start a family how will you manage? (What would you tell her concerning her lithium, what are the risks when you stop, percentage of women who get psychotic in pregnancy if lithium stopped, what if she continues, side effects and effects on the baby, what if she wants to stop lithium- would you stop 'just like that' or do something else, over what period of time you would reduce lithium, what if she is well afterwards, would you restart lithium , how soon, what settings in, what if she remains well in this pregnancy and wants to have another baby- what would you advise re. risk of relapse- still high? What would you tell the patient re risk. What is the risk of relapse following birth?)

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would like to know about the previous episodes,how severe and whether risk to herself or others in those. whether any other prophylactic meds tried before. Her current mental state. Discussion re stopping or not stopping.

Mention about ebstein's anomaly ( tricuspid valve), risk in the first trimester, echo needed at 6 & 18 weeks pregnancy, max chances of getting it in 2nd to 6th week even before she knows she is pregnant. Hence the need to have a planned and gradual withdrawal of lithium because abrupt withdrawal - more chances of manic relapse. Can be restarted after the first trimester, need to monitor levels more frequently, at least once weekly in the last trimester because of fluid changes, hence dose titration needed, need to stop lithium at least 24 hrs before delivery because levels fall. Need to have peaditrician along at the time of delivery as the baby can have hypotonia and poor sucking reflex. Need to liase with midwife, obstetrician. Partner needed to be involved in discussions.

Valproate and CBZ not much recommended - neural tube defects.

If she agrees stopping lithium - has manic relapse during pregancy - haloperidol or chlorpromazine. Data on atypicals limited.

Chances of relapse in puerpurium about 50-90%. Role of social support, partner, finances etc.

Whether she knows that risk of inheritance to baby is 10%

At the end of the day it is her own choice.

After delivery - restart lithium if stopped but then cant breast feed and if she insists - then issues of harming the child - child protection issues.

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hi, So stop the lithium the previous day and resume soon after delivery???Restart on the same dose or higher?

Thank you

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Dose of Lithium will be higher just before delivery because of the accummulation of water during pregnancy. Water levels come abruptly back to pre-pregnancy levels after delivery. Dose of Lithium will most likely have to be lower. Start at a lower dose and check levels.

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