Regarding the use of lithium in pregnancy, which specific fetal risk has been documented and should prompt a detailed second-trimester fetal echocardiogram?
- A Ebstein's anomaly of the tricuspid valve ✓
- B Neural tube defect
- C Holoprosencephaly
- D Gastroschisis
Correct answer: A. Ebstein's anomaly of the tricuspid valve
Explanation
First-trimester lithium exposure is associated with a small but real increase in Ebstein's anomaly (downward displacement of the tricuspid valve with sail-shaped anterior leaflet). The absolute risk is low (about 0.1% vs 0.005% background), but current guidelines recommend a detailed fetal echocardiogram and level-2 ultrasound at 16–20 weeks. Valproate is associated with neural tube defects; lithium's primary teratogenic concern is cardiac. Lithium should not be abruptly discontinued in pregnancy due to high relapse risk for bipolar disorder.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.