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Let’s look at lithium and its risks in pregnancy. We have been taught that lithium exposure in the first trimester increases the risk of cardiac abnormalities, like the Ebstein anomaly. Well, that risk went down from about 1 in 100 to 1 in 1,000 during my years of practice. Now, here comes some new data on the risk of lithium in pregnancy from 2 large meta-analyses published in the last year. They arrived at somewhat different conclusions, but the bottom line is still pretty straightforward.
First, in June 2018, they used a large sample with these 6 cohorts and found no risk of cardiac abnormalities with first-trimester or any trimester exposure to lithium. However, in the newer meta-analysis just published in the American Journal of Psychiatry , which looks more broadly in the literature for a total of 13 comparison studies between exposed and unexposed patients, they found that cardiac
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