For women with bipolar disorder who are thinking about pregnancy, and for their families: what the pooled studies say about the riskiest weeks after birth, and why they cannot yet settle the choice of treatment.
On 26 October 2026 The Journal of Clinical Psychiatry published a systematic review and meta-analysis from Western University in London, Ontario, led by psychiatrist Verinder Sharma. The team asked a narrow question: among women with bipolar I or II disorder, how often does the illness return after childbirth in those who take lithium to prevent it, compared with those who do not? Lithium has been approved and used for decades for bipolar disorder, but its use specifically in the postpartum period, the authors write, has received much less attention.
The weeks after birth are a known high-risk time
The question matters because the risk is not small. In a 2016 meta-analysis in the American Journal of Psychiatry, which pooled 37 studies with 5,700 deliveries in 4,023 women with bipolar disorder or a history of postpartum psychosis, about one in three (35%) had a relapse after giving birth. Among women with bipolar disorder, relapse was reported in 66% of those who took no medication during pregnancy and in 23% of those who took preventive medication.
Eight studies provide the comparison, not one trial
The new review searched PubMed, PsycINFO and the Cochrane databases on 2 April 2026 for English-language studies and screened 45 of them. Eight studies, with 554 women in total, reported how often the illness returned after birth with and without preventive lithium. The pooled share of women with a recurrence was 21% (95% CI 15–29%) among those treated with lithium and 41% (95% CI 33–50%) among those not treated with it. The most common time to start prevention was during pregnancy (51.9%). Two further studies looked at what happened when lithium was stopped, and, according to the authors, gave indirect support to the same conclusion.
Why this does not yet settle the choice
All of the evidence comes from observational studies. Women who stayed on lithium may have differed from those who did not. The authors themselves name this problem, confounding by indication, without showing how the groups differed, and call the literature limited: eight studies, English only. The figures of 21% and 41% are pooled shares in two groups, not the result of a trial in which women were randomly assigned to lithium or no lithium. The abstract does not name a funding source; the authors declare no conflicts of interest. The review was registered in advance (PROSPERO CRD420261357096).
The other side of the scale is the pregnancy itself
The decision about lithium is a balance, and the review measured only one side of it. In a 2018 meta-analysis in The Lancet Psychiatry, which combined six cohorts from Denmark, Sweden, Canada, the Netherlands, the United Kingdom and the United States, lithium during pregnancy was not associated with any of the predefined pregnancy complications or delivery outcomes. Exposure in the first trimester was associated with more major malformations: 7.4% compared with 4.3% in women with mood disorders who did not take lithium. In that analysis, newborns exposed to lithium were also readmitted to hospital within 28 days of birth more often, 27.5% compared with 14.3%. The authors of that analysis concluded that these risks have to be weighed against how well lithium prevents relapse.
For a woman with bipolar disorder who is thinking about a pregnancy, the practical point is timing: a plan for pregnancy and for the first weeks after birth can be made in advance, ideally before conception, together with a psychiatrist and an obstetrician. Whether to continue, start or change a medicine is a decision to discuss with your doctor. The new review adds one more piece to that conversation: in the studies available so far, the pooled shares of recurrence after birth were 21% with lithium and 41% without, but this comparison cannot establish that lithium caused the difference.
This article is for information only and does not replace a consultation with a doctor. Nothing in it is a recommendation to start, stop or change any treatment.
Sources
Sharma V, et al. Lithium in the Prevention of Postpartum Recurrence of Mood Disorders: A Systematic Review and Meta-Analysis. J Clin Psychiatry. 2026. PMID 42949427
Wesseloo R, et al. Risk of Postpartum Relapse in Bipolar Disorder and Postpartum Psychosis: A Systematic Review and Meta-Analysis. Am J Psychiatry. 2016. PMID 26514657
Munk-Olsen T, et al. Maternal and infant outcomes associated with lithium use in pregnancy: an international collaborative meta-analysis of six cohort studies. Lancet Psychiatry. 2018. PMID 29929874
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Articles in this section are educational and are not medical advice, a diagnosis, or a prescription. Consult a qualified professional before acting on anything you read here.
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