Definition:   Cardiac anomaly (see below) and possible goiter due to maternal ingestion of lithium for manic-depressive disorder.

Synonyms: None.

Incidence:  Very rare

Etiology: Maternal exposure to lithium. A report in the 1970 associated the maternal use of lithium with Ebstein anomaly (with a 400% risk factor)[1],[2],[3]. More recent data have not supported this finding[4],[5],[6]. The final answer is probably that there might be a very small increase, but that it is infrequent enough that it should not be the cause for discontinuing treatment.

Recurrence risk: None.

Diagnosis: Aside from the exceptional Ebstein anomaly, goiter and polyhydramnios[7] and oromandibular-limb hypogenesis[8] or even stillbirth[9] have been reported.

Pathogenesis: Unknown.

Genetic anomaly: None

Associated anomalies: None

Differential diagnosis: None

Prognosis: Dependent on the severity of the anomaly if they exist.

Management: No alteration of management indicated.

References:

[1] Weinstein MR, Goldfield M Cardiovascular malformations with lithium use during pregnancy. Am J Psychiatry 1975 May;132(5):529-31

[2] Park JM, Sridaromont S, Ledbetter EO, Terry WM: Ebstein"s anomaly of the tricuspid valve associated with prenatal exposure to lithium carbonate. Am J Dis Child 1980 Jul;134(7):703-4

[3] Nora JJ, Nora AH, Toews WH: Lithium, Ebstein"s anomaly, and other congenital heart defects. Lancet 1974 Sep 7;2(7880):594-5

[4] Cohen LS, Friedman JM, Jefferson JW, Johnson EM, Weiner ML A reevaluation of risk of in utero exposure to lithium. JAMA 1994 Jan 12;271(2):146-50

[5] Jacobson SJ, Jones K, Johnson K, Ceolin L, Kaur P, Sahn D, Donnenfeld AE, Rieder M, Santelli R, Smythe J, et al Prospective multicentre study of pregnancy outcome after lithium exposure during first trimester. Lancet 1992 Feb 29;339(8792):530-3

[6] Zalzstein E, Koren G, Einarson T, Freedom RM A case-control study on the association between first trimester exposure to lithium and Ebstein"s anomaly. Am J Cardiol 1990 Mar 15;65(11):817-8

[7] Ang MS, Thorp JA, Parisi VM Maternal lithium therapy and polyhydramnios. Obstet Gynecol 1990 Sep;76(3 Pt 2):517-9

[8] Tekin M, Ellison J. Oromandibular-limb hypogenesis spectrum and maternal lithium use.

Clin Dysmorphol. 2000 Apr;9(2):139-41.

[9] Khandelwal SK, Sagar RS, Saxena S Lithium in pregnancy and still birth: a case report. Br J Psychiatry 1989 Jan;154:114-6