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June 15, 1994

The Risk of In Utero Exposure to Lithium-Reply

Author Affiliations

Massachusetts General Hospital Boston

JAMA. 1994;271(23):1828-1829. doi:10.1001/jama.1994.03510470032025

In Reply.  —We are pleased that Drs Kellner, Beale, and Pritchett appreciate our recent attempt to describe a revised estimate of risk associated with in utero exposure to lithium carbonate. It was one of our main goals to underscore the clinical implications of a more modest risk associated with first-trimester exposure to lithium with respect to the clinical management of women with bipolar disorder who were planning to conceive or who inadvertently became pregnant. While the safe use of ECT during pregnancy has been well described,1 good follow-up studies of these pregnancies are limited.2 While it may not be safer than psychotropic drug use during pregnancy, ECT is clearly the treatment of choice for psychiatrically ill pregnant women when expeditious treatment is imperative such as in the setting of mania or psychotic depression, where the risk of untreated disorder, ie, danger from impulsive behaviors, psychosis, and self-harm, place

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