A woman with bipolar I disorder is 28 weeks pregnant. She has previously relapsed rapidly and severely when lithium was withdrawn, and antipsychotic

Question

A woman with bipolar I disorder is 28 weeks pregnant. She has previously relapsed rapidly and severely when lithium was withdrawn, and antipsychotic prophylaxis was ineffective. Following specialist perinatal review, she has chosen to continue lithium. Her renal function is normal and her stable 12-hour plasma lithium level is 0.7 mmol/L. According to NICE guidance, which plan for lithium-level monitoring and management through the remainder of pregnancy and labour is most appropriate?

Accepted Answer

Check levels every 4 weeks until week 36 and then weekly; monitor the level and fluid balance when labour starts, stop lithium during labour, and check the level 12 hours after the last dose

Answer

Check levels weekly from week 28; continue lithium during labour if fluid balance remains normal and check the level 12 hours after delivery

Answer

Check levels every 4 weeks until delivery; stop lithium when labour starts and check the level 24 hours after delivery

Answer

Check levels every 4 weeks until week 36; routinely stop lithium at week 36 and restart it immediately after delivery without an additional level

Answer

Check levels every 4 weeks until week 36 and then every 2 weeks; continue lithium during labour and check the level 24 hours postpartum

Lithium in Pregnancy — MRCPsych Paper B MCQ