Imagine you have a 35-year old childless woman with bipolar disorder currently in remission on lithium. She and her partner want to have a child. Considering her history you feel that discontinuation of lithium is highly risky and her getting pregnant would exponentially increase the probability of disastrous outcomes for her, her partner and the future pregnancy. How are you going to do the decision making involving her and her partner?
http://www.nami.org/Content/ContentGroups/Research/Managing_Pregnancy_and_Bipolar_Disorder.htm
The main teratogenic effect of lithium is a tenfold increase of a very rare severe cardiac malformation which is caused around the 10 gestational week. Thereafter lithium-loss of effect (or intoxication after adjustment) may be a problem because of a large increase in body water especially if pre-eclampsia develops (which seems more common in bipolarity). Therefore body weight should be followed nearly on a daily basis. When an increase of more than 20 kg has been witnessed pre-eclampsia is very likely and magnesium therapy should be instituted. Pregnancy is a state of tolerance with inhibition of adaptive immunity and increase in innate immunity which is related to bipolar disorder. Risks of pregnancy are closely related to mucosal infections anywhere and therefore these should be treated. Lithium possibly inhibits innate immunity.
That's the way I would see it. Kr gt
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