PhD defence E.M.P. (Eline) Poels

Bipolar disorder is a psychiatric disorder, characterised by recurrent episodes of depression and (hypo)mania. Lithium is the most effective pharmacological treatment for the prevention of both manic and depressive episodes. For this reason, lithium is often the pharmacological treatment of choice for individuals with bipolar disorder. It is prescribed to women of childbearing age and it may be continued during pregnancy. It is therefore of high importance to know what the potential consequences are for the unborn child. Previous studies have mostly focused on the risk of congenital malformations and showed an increased risk of congenital malformations associated with lithium use during the first trimester of pregnancy. The aim of this thesis was to expand the knowledge of potential consequences by investigating the risk of miscarriage, the influence on fetal growth and birth weight and the long-term consequences for neuropsychological functioning. In addition we investigated whether lithium should be discontinued prior to delivery to prevent neonatal complications. Based on the research described in this thesis we conclude that lithium use during pregnancy is not only associated with a small but increased risk of congenital malformations, but also with an increased risk of miscarriage and increased fetal growth and birth weight. Since lithium blood levels around delivery remain stable and neonatal lithium blood levels are not associated with neonatal complications when lithium is dosed within the therapeutic range, we do not advise to reduce the dose prior to delivery. The data on the long-term development of lithium-exposed children are reassuring. Women of childbearing age requiring mood stabilisation, should be given the opportunity to weigh the risks and benefits of lithium treatment during pregnancy.

The PhD defences will not take place publicly in the usual way. A live stream link has been provided to candidate. The ceremony will begin exactly at 15:30.