The use of lithium and other anticonvulsant mood stabilizers were not associated with a higher risk for placenta-mediated complications in a large cohort of pregnant women, according to study results published in the Journal of Clinical Psychiatry.
Researchers conducted a retrospective cohort study of women exposed to mood stabilizer monotherapy (n=10,575) or polytherapy (n=917) during the first 20 weeks of pregnancy. Data was collected from the Medicaid Analytic eXtract database from 2000 to 2010. Exposures included oxcarbazepine, topiramate, carbamazepine, lamotrigine, valproate, and lithium. The outcomes of interest were the risk for placental abruption, preterm birth, growth restriction, and preeclampsia with each respective exposure.
After analysis, the researchers found that after adjusting for confounding by indication, mood stabilizer use was not associated with a higher risk for preterm birth or placenta-related complications (relative risk range, 0.89-1.16). In addition, maintenance therapy with any mood stabilizer was not associated with a greater risk for adverse pregnancy outcomes.
One key study limitation was the use of administrative data; also, the investigators inferred indication from diagnoses observed at baseline and during pregnancy.
“This study should provide reassurance to clinicians and their patients that mood stabilizer treatment is unlikely to be responsible for this increased risk,” the researchers wrote.
“It is still important to consider pregnancy-related use of mood stabilizers, especially valproate, in light of other evidence for teratogenicity,” they concluded.
Cohen JM, Huybrechts KF, Patorno E, et al. Anticonvulsant mood stabilizer and lithium use and risk of adverse pregnancy outcomes. J Clin Psychiatry. 2019;80(4):18m12572.