Lithium: Managing Bipolar Disorder in Childbearing Women
Monograph
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Course Summary
Bipolar disorder is a common and serious psychiatric condition, which often has disabling consequences for those afflicted by it. Women have the highest risk of being diagnosed with bipolar or having a recurring episode during pregnancy or within one year of giving birth. During pregnancy and the postpartum period, lithium has been identified as an effective treatment to control symptoms of bipolar disorder and as a prevention of a relapse of symptoms. Fluctuations in serum lithium levels may occur during pregnancy and the postpartum period that can lead to subtherapeutic or supratherapeutic lithium levels. In addition, there are risks with lithium use during pregnancy for the mother and fetus. During the first trimester of pregnancy, there is a potential for congenital malformations due to lithium exposure in utero. There may also be an increased risk of miscarriage from lithium use. The decision to prescribe lithium during pregnancy should be determined by considering the risk factors of using lithium and balancing them with the risk of mood dysregulation and psychosis for the mother. Continuing lithium use during pregnancy requires close monitoring during the perinatal period, including frequent testing of lithium serum levels. Consideration must also be made for mothers who intend to breastfeed.
Course Objectives
Describe the potential risks of lithium use during pregnancy
Describe the fluctuations in serum lithium levels during pregnancy and the postpartum period, leading to subtherapeutic or supratherapeutic lithium levels.
Review the 2023 American College of Obstetricians and Gynecologists guidelines for lithium use during pregnancy and postpartum.
Describe the lithium laboratory test monitoring in pregnant and postpartum women who are prescribed lithium
I. Introduction
II. Bipolar Disorder and Suicidal Ideation in Pregnant Women
III. To Treat or Not to Treat? A Clinical Conundrum
1. Efficacy of Prescribing Lithium in Childbearing Women
2. Potential Risks from Lithium Use During Pregnancy
3. Teratogenic Risks
4. Risk of Spontaneous Preterm Birth
5. Risk of Miscarriage
IV. Managing Lithium’s Teratogenic, Miscarriage, and Suicide Risks
1. Managing Teratogenic Risks
2. Managing the Risk of Miscarriage
3. Managing Suicide Risks
V. Lithium Pharmacokinetics in the Perinatal Period
VI. Laboratory Testing and Monitoring
VII. Lithium Dosing Adjustments During Pregnancy
VIII. Lithium Adverse Events and Poisoning
IX. Lithium and Breastfeeding
X. The American College of Obstetricians and Gynecologists (ACOG) Guidelines
XI. Alternative Drugs During Pregnancy
XII. Lithium Use During Pregnancy Case Reports
1. Case Report I
2. Case Report II
3. Case Report III
XIII. Key Points
XIV. Summary
- Read the course objectives and faculty planner disclosure
- Read the course material
- Complete the post-test with a minimum score of 70% and complete the course evaluation form.
- Results are automatically submitted to CPE Monitor
Faculty Planner Disclosure
The following individuals were involved in developing this activity: Douglas Evans, APRN, PMHNP-BC, Anna S. Smith, MPH, BSN-RN, and Pamela Sardo, PharmD, BS. There are no financial relationships relevant to this activity to report or disclose by any of the individuals involved in the development of this activity.
Unlabeled Use Disclosures
The information provided in this course is general in nature and it is solely designed to provide participants with continuing education credit(s). This course and materials are not meant to substitute for the independent, professional judgment of any participant regarding that participant’s professional practice, including but not limited to patient assessment, diagnosis, treatment and/or health management. Medical and pharmacy practices, rules, and laws vary from state to state, and this course does not cover the laws of each state; therefore, participants must consult the laws of their state as they relate to their professional practice. Healthcare professionals, including pharmacists and pharmacy technicians, must consult with their employer, healthcare facility, hospital, or other organization, for guidelines, protocols, and procedures they are to follow. The information provided in this course does not replace those guidelines, protocols, and procedures but is for academic purposes only, and this course’s limited purpose is for the completion of continuing education credits. Participants are advised and acknowledge that information related to medications, their administration, dosing, contraindications, adverse reactions, interactions, warnings, precautions, or accepted uses are constantly changing, and any person taking this course understands that such person must make an independent review of medication information prior to any patient assessment, diagnosis, treatment and/or health management. Any discussion of off-label use of any medication, device, or procedure is informational only and such uses are not endorsed hereby. Nothing contained in this course represents the opinions, views, judgments, or conclusions of RxCe.com LLC. RxCe.com LLC is not liable or responsible to any person for any inaccuracy, error, or omission with respect to this course, or course material.
Computer Hardware/Software Requirements
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- Target Audience: Pharmacist
- Contact Hours: 2.0 (0.2 CEUs)
- Activity Release Date: 8/2/2023
- Activity Expiration Date: 8/2/2026
- Activity Type: Knowledge
- UAN: 0669-0000-23-111-H01-P
- Topic: Disease State Management/Drug Therapy
- CeBroker Number: 20-1093934
Author:
RxCe.com, LLC is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.