Lithium Use During Pregnancy in 14 Countries
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. To examine lithium use in the perinatal period. This...
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creator | Wittström, Felix Cesta, Carolyn E Bateman, Brian T Bendix, Marie Bliddal, Mette Chan, Adrienne Y L Cho, Yongtai Choi, Eun-Young Cohen, Jacqueline M Donald, Sarah Gissler, Mika Havard, Alys Hernandez-Diaz, Sonia Huybrechts, Krista F Kollhorst, Bianca Lai, Edward Chia-Cheng Leinonen, Maarit K Li, Brian M H Man, Kenneth K C Ng, Vanessa W S Parkin, Lianne Pazzagli, Laura Rasmussen, Lotte Rotem, Ran S Schink, Tania Shin, Ju-Young Tran, Duong T Wong, Ian C K Zoega, Helga Reutfors, Johan |
description | 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.
To examine lithium use in the perinatal period.
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.
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.
Comparison of prevalence between the first and last 3-year periods of available data.
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.
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 |
doi_str_mv | 10.1001/jamanetworkopen.2024.51117 |
format | Article |
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To examine lithium use in the perinatal period.
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.
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.
Comparison of prevalence between the first and last 3-year periods of available data.
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.
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.</description><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2024.51117</identifier><identifier>PMID: 39680408</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Adult ; Antimanic Agents - therapeutic use ; Australia - epidemiology ; Cohort Studies ; Female ; Germany - epidemiology ; Humans ; Israel - epidemiology ; Lithium - therapeutic use ; Lithium Compounds - therapeutic use ; Mental Disorders - drug therapy ; Mental Disorders - epidemiology ; Online Only ; Original Investigation ; Pregnancy ; Pregnancy Complications - drug therapy ; Pregnancy Complications - epidemiology ; Psychiatry ; Republic of Korea - epidemiology ; Taiwan - epidemiology ; United Kingdom - epidemiology ; United States - epidemiology</subject><ispartof>JAMA network open, 2024-12, Vol.7 (12), p.e2451117</ispartof><rights>Copyright 2024 Wittström F et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,864,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39680408$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wittström, Felix</creatorcontrib><creatorcontrib>Cesta, Carolyn E</creatorcontrib><creatorcontrib>Bateman, Brian T</creatorcontrib><creatorcontrib>Bendix, Marie</creatorcontrib><creatorcontrib>Bliddal, Mette</creatorcontrib><creatorcontrib>Chan, Adrienne Y L</creatorcontrib><creatorcontrib>Cho, Yongtai</creatorcontrib><creatorcontrib>Choi, Eun-Young</creatorcontrib><creatorcontrib>Cohen, Jacqueline M</creatorcontrib><creatorcontrib>Donald, Sarah</creatorcontrib><creatorcontrib>Gissler, Mika</creatorcontrib><creatorcontrib>Havard, Alys</creatorcontrib><creatorcontrib>Hernandez-Diaz, Sonia</creatorcontrib><creatorcontrib>Huybrechts, Krista F</creatorcontrib><creatorcontrib>Kollhorst, Bianca</creatorcontrib><creatorcontrib>Lai, Edward Chia-Cheng</creatorcontrib><creatorcontrib>Leinonen, Maarit K</creatorcontrib><creatorcontrib>Li, Brian M H</creatorcontrib><creatorcontrib>Man, Kenneth K C</creatorcontrib><creatorcontrib>Ng, Vanessa W S</creatorcontrib><creatorcontrib>Parkin, Lianne</creatorcontrib><creatorcontrib>Pazzagli, Laura</creatorcontrib><creatorcontrib>Rasmussen, Lotte</creatorcontrib><creatorcontrib>Rotem, Ran S</creatorcontrib><creatorcontrib>Schink, Tania</creatorcontrib><creatorcontrib>Shin, Ju-Young</creatorcontrib><creatorcontrib>Tran, Duong T</creatorcontrib><creatorcontrib>Wong, Ian C K</creatorcontrib><creatorcontrib>Zoega, Helga</creatorcontrib><creatorcontrib>Reutfors, Johan</creatorcontrib><title>Lithium Use During Pregnancy in 14 Countries</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>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.
To examine lithium use in the perinatal period.
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.
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.
Comparison of prevalence between the first and last 3-year periods of available data.
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.
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.</description><subject>Adult</subject><subject>Antimanic Agents - therapeutic use</subject><subject>Australia - epidemiology</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Germany - epidemiology</subject><subject>Humans</subject><subject>Israel - epidemiology</subject><subject>Lithium - therapeutic use</subject><subject>Lithium Compounds - therapeutic use</subject><subject>Mental Disorders - drug therapy</subject><subject>Mental Disorders - epidemiology</subject><subject>Online Only</subject><subject>Original Investigation</subject><subject>Pregnancy</subject><subject>Pregnancy Complications - drug therapy</subject><subject>Pregnancy Complications - epidemiology</subject><subject>Psychiatry</subject><subject>Republic of Korea - epidemiology</subject><subject>Taiwan - epidemiology</subject><subject>United Kingdom - epidemiology</subject><subject>United States - epidemiology</subject><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVj1tLw0AUhBdBbKn9CxJ8NvWcvWXzJFKtCgV9qM9hkz1JtzabkovSf2_AC_o0MMN8wzB2ibBAALze2doG6j-a9q05UFhw4HKhEDE5YVOuEhkLA2rC5l23AwAOKFKtzthkFAMSzJRdrX2_9UMdvXYU3Q2tD1X00lIVbCiOkQ8RymjZDKFvPXXn7LS0-47m3zpjm9X9ZvkYr58fnpa369imBuJCWO4UGl5wSLUEkoZKnTqOudYqKdMcTZmWPC8dOmFJi4Kcs6MFpBxPxIzdfGEPQ16TK2hct_vs0PratsessT77nwS_zarmPUPUCiTCSLj4S_it_vwWn3L6XmY</recordid><startdate>20241202</startdate><enddate>20241202</enddate><creator>Wittström, Felix</creator><creator>Cesta, Carolyn E</creator><creator>Bateman, Brian T</creator><creator>Bendix, Marie</creator><creator>Bliddal, Mette</creator><creator>Chan, Adrienne Y L</creator><creator>Cho, Yongtai</creator><creator>Choi, Eun-Young</creator><creator>Cohen, Jacqueline M</creator><creator>Donald, Sarah</creator><creator>Gissler, Mika</creator><creator>Havard, Alys</creator><creator>Hernandez-Diaz, Sonia</creator><creator>Huybrechts, Krista F</creator><creator>Kollhorst, Bianca</creator><creator>Lai, Edward Chia-Cheng</creator><creator>Leinonen, Maarit K</creator><creator>Li, Brian M H</creator><creator>Man, Kenneth K C</creator><creator>Ng, Vanessa W S</creator><creator>Parkin, Lianne</creator><creator>Pazzagli, Laura</creator><creator>Rasmussen, Lotte</creator><creator>Rotem, Ran S</creator><creator>Schink, Tania</creator><creator>Shin, Ju-Young</creator><creator>Tran, Duong T</creator><creator>Wong, Ian C K</creator><creator>Zoega, Helga</creator><creator>Reutfors, Johan</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>5PM</scope></search><sort><creationdate>20241202</creationdate><title>Lithium Use During Pregnancy in 14 Countries</title><author>Wittström, Felix ; Cesta, Carolyn E ; Bateman, Brian T ; Bendix, Marie ; Bliddal, Mette ; Chan, Adrienne Y L ; Cho, Yongtai ; Choi, Eun-Young ; Cohen, Jacqueline M ; Donald, Sarah ; Gissler, Mika ; Havard, Alys ; Hernandez-Diaz, Sonia ; Huybrechts, Krista F ; Kollhorst, Bianca ; Lai, Edward Chia-Cheng ; Leinonen, Maarit K ; Li, Brian M H ; Man, Kenneth K C ; Ng, Vanessa W S ; Parkin, Lianne ; Pazzagli, Laura ; Rasmussen, Lotte ; Rotem, Ran S ; Schink, Tania ; Shin, Ju-Young ; Tran, Duong T ; Wong, Ian C K ; Zoega, Helga ; Reutfors, Johan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a980-c3a2d5182c209640e48ef69d21b6657f9b18f9f2bfd1d3ae63ceddaf9f0e5d273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Antimanic Agents - therapeutic use</topic><topic>Australia - epidemiology</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Germany - epidemiology</topic><topic>Humans</topic><topic>Israel - epidemiology</topic><topic>Lithium - therapeutic use</topic><topic>Lithium Compounds - therapeutic use</topic><topic>Mental Disorders - drug therapy</topic><topic>Mental Disorders - epidemiology</topic><topic>Online Only</topic><topic>Original Investigation</topic><topic>Pregnancy</topic><topic>Pregnancy Complications - drug therapy</topic><topic>Pregnancy Complications - epidemiology</topic><topic>Psychiatry</topic><topic>Republic of Korea - epidemiology</topic><topic>Taiwan - epidemiology</topic><topic>United Kingdom - epidemiology</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wittström, Felix</creatorcontrib><creatorcontrib>Cesta, Carolyn E</creatorcontrib><creatorcontrib>Bateman, Brian T</creatorcontrib><creatorcontrib>Bendix, Marie</creatorcontrib><creatorcontrib>Bliddal, Mette</creatorcontrib><creatorcontrib>Chan, Adrienne Y L</creatorcontrib><creatorcontrib>Cho, Yongtai</creatorcontrib><creatorcontrib>Choi, Eun-Young</creatorcontrib><creatorcontrib>Cohen, Jacqueline M</creatorcontrib><creatorcontrib>Donald, Sarah</creatorcontrib><creatorcontrib>Gissler, Mika</creatorcontrib><creatorcontrib>Havard, Alys</creatorcontrib><creatorcontrib>Hernandez-Diaz, Sonia</creatorcontrib><creatorcontrib>Huybrechts, Krista F</creatorcontrib><creatorcontrib>Kollhorst, Bianca</creatorcontrib><creatorcontrib>Lai, Edward Chia-Cheng</creatorcontrib><creatorcontrib>Leinonen, Maarit K</creatorcontrib><creatorcontrib>Li, Brian M H</creatorcontrib><creatorcontrib>Man, Kenneth K C</creatorcontrib><creatorcontrib>Ng, Vanessa W S</creatorcontrib><creatorcontrib>Parkin, Lianne</creatorcontrib><creatorcontrib>Pazzagli, Laura</creatorcontrib><creatorcontrib>Rasmussen, Lotte</creatorcontrib><creatorcontrib>Rotem, Ran S</creatorcontrib><creatorcontrib>Schink, Tania</creatorcontrib><creatorcontrib>Shin, Ju-Young</creatorcontrib><creatorcontrib>Tran, Duong T</creatorcontrib><creatorcontrib>Wong, Ian C K</creatorcontrib><creatorcontrib>Zoega, Helga</creatorcontrib><creatorcontrib>Reutfors, Johan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA network open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wittström, Felix</au><au>Cesta, Carolyn E</au><au>Bateman, Brian T</au><au>Bendix, Marie</au><au>Bliddal, Mette</au><au>Chan, Adrienne Y L</au><au>Cho, Yongtai</au><au>Choi, Eun-Young</au><au>Cohen, Jacqueline M</au><au>Donald, Sarah</au><au>Gissler, Mika</au><au>Havard, Alys</au><au>Hernandez-Diaz, Sonia</au><au>Huybrechts, Krista F</au><au>Kollhorst, Bianca</au><au>Lai, Edward Chia-Cheng</au><au>Leinonen, Maarit K</au><au>Li, Brian M H</au><au>Man, Kenneth K C</au><au>Ng, Vanessa W S</au><au>Parkin, Lianne</au><au>Pazzagli, Laura</au><au>Rasmussen, Lotte</au><au>Rotem, Ran S</au><au>Schink, Tania</au><au>Shin, Ju-Young</au><au>Tran, Duong T</au><au>Wong, Ian C K</au><au>Zoega, Helga</au><au>Reutfors, Johan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Lithium Use During Pregnancy in 14 Countries</atitle><jtitle>JAMA network open</jtitle><addtitle>JAMA Netw Open</addtitle><date>2024-12-02</date><risdate>2024</risdate><volume>7</volume><issue>12</issue><spage>e2451117</spage><pages>e2451117-</pages><eissn>2574-3805</eissn><abstract>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.
To examine lithium use in the perinatal period.
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.
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.
Comparison of prevalence between the first and last 3-year periods of available data.
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.
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.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>39680408</pmid><doi>10.1001/jamanetworkopen.2024.51117</doi><oa>free_for_read</oa></addata></record> |
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subjects | Adult Antimanic Agents - therapeutic use Australia - epidemiology Cohort Studies Female Germany - epidemiology Humans Israel - epidemiology Lithium - therapeutic use Lithium Compounds - therapeutic use Mental Disorders - drug therapy Mental Disorders - epidemiology Online Only Original Investigation Pregnancy Pregnancy Complications - drug therapy Pregnancy Complications - epidemiology Psychiatry Republic of Korea - epidemiology Taiwan - epidemiology United Kingdom - epidemiology United States - epidemiology |
title | Lithium Use During Pregnancy in 14 Countries |
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