Journal article
Lithium prescribing in the perinatal period: UK primary care cohort study
British journal of psychiatry, pp 1-7
17 Apr 2026
PMID: 41992689
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Abstract
Although lithium has been used effectively as a medication to treat bipolar and major depressive disorders, there are limited data defining lithium use patterns during pregnancy.
To investigate trends and patterns of lithium prescribing in the perinatal period (before, during and after pregnancy) among pregnancies in the UK.
We conducted a population-based study using primary healthcare records from the Clinical Practice Research Datalink GOLD, analysing 752 112 pregnancies during the period 1995-2018. We assessed the prevalence and patterns of lithium prescriptions, including discontinuation, continuation and dosage. Maternal characteristics were defined for lithium non-users and users, and between those who continued and discontinued use.
From 1995 to 2018, the prevalence of lithium prescribing per 10 000 pregnancies was 3.02 (95% CI: 2.64, 3.44) before pregnancy, 1.89 (95% CI: 1.59, 2.23) during pregnancy and 2.81 (95% CI: 2.44, 3.21) postpartum. Prescribing during pregnancy was low across the study period, with the most recent prevalence in 2018 of 1.03 (95% CI: 0.26, 4.11) per 10 000 pregnancies. Among 337 pregnancies with perinatal lithium prescribing, 48.4% involved a diagnosis of bipolar disorder. Of 227 pregnancies where lithium was prescribed preconception, 15.4% continued treatment throughout pregnancy; discontinuation occurred before pregnancy in 20.7%, and during second or third trimester in 30.8%; 33.0% followed other prescribing patterns. Women who discontinued lithium were more likely to be younger, have a body mass index ≥30 kg/m
, a diagnosis of bipolar disorder, a history of smoking and >10 primary care consultations in the 12 months preconception, compared with those who continued treatment.
Lithium prescribing during pregnancy in the UK is uncommon and discontinuation is frequent, particularly in the later stages of pregnancy. These findings highlight the need for proactive perinatal mental healthcare strategies and close clinical monitoring, to reduce unintentional first-trimester exposure while ensuring continuity of care for maternal mental health.
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Details
- Title
- Lithium prescribing in the perinatal period: UK primary care cohort study
- Creators
- Deepika Chauhan - Drexel UniversityPaul Madley-Dowd - University of BristolJoseph F Hayes - University College LondonJessica E Rast - Drexel UniversityViktor H Ahlqvist - Karolinska InstitutetFlorence Z Martin - University of BristolCecilia Magnusson - Karolinska InstitutetDheeraj Rai - University of BristolBrian K Lee - Drexel University
- Publication Details
- British journal of psychiatry, pp 1-7
- Publisher
- Cambridge University Press
- Number of pages
- 7
- Grant note
- NIH: 1R01NS107607, 1R01NS131433 HR Biomedical Research Centre at the University of Bristol and University Hospitals Bristol and Weston NHS Foundation Trust: NIHR203315 Medical Research Council Integrative Epidemiology Unit at the University of Bristol - UK Medical Research Council University of Bristol: MC_UU_00032/02, MC_UU_00032/06 Swedish Society for Medical Research: PG-24-0427
This study was supported by NIH nos 1R01NS107607 (B.K.L., D.C., J.E.R., V.H.A., D.R., C.M.) and 1R01NS131433 (B.K.L., J.E.R., V.H.A., D.C.). This study was also supported by the NIHR Biomedical Research Centre at the University of Bristol and University Hospitals Bristol and Weston NHS Foundation Trust (no. NIHR203315; P.M.-D., D.R.). P.M.-D. and D.R. work in the Medical Research Council Integrative Epidemiology Unit at the University of Bristol, which is supported by the UK Medical Research Council and the University of Bristol (nos MC_UU_00032/02, MC_UU_00032/06; P.M.-D., D.R.). V.H.A. is funded by the Swedish Society for Medical Research (no. PG-24-0427). No funder had any role in the study design, data collection, analysis or interpretation, writing ofthe report or in the decision to submit the article for publication. The views expressed are thoseof the authors and not necessarily those of any of the funders or organisations they represent
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics; A.J. Drexel Autism Institute
- Web of Science ID
- WOS:001742211300001
- Other Identifier
- 991022173650404721