Pregnancy lithium therapy

In considering whether to maintain patients on lithium during pregnancy, the clinician must take into account the risks of an exacerbation of bipolar disorder to both mother and fetus. Although it would be ideal to avoid lithium therapy, at least during the first trimester, when critical organogenesis is occurring, this may not be possible. 

ACE inhibitors are absolutely contraindicated in pregnancy (see Pregnancy section under Special Populations ) and in patients with a history of angioedema. Similar to diuretics, ACE inhibitors can increase lithium serum concentrations in patients on lithium therapy. Concurrent use of an ACE inhibitor with a potassium-sparing diuretic (including aldosterone antagonists), potassium supplements, or an ARB may result in excessive increases in potassium. 

Electroconvulsive therapy (ECT) is used for severe mania or depression during pregnancy and for mixed episodes prior to treatment, anticonvulsants, lithium, and benzodiazepines should be tapered off to maximize therapy and minimize adverse effects. 

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