There is a fragile balance between the management of bipolar disorder and pregnancy when it comes to the benefits versus the risks of recommended treatments. Women who become pregnant with a chronic mental illness should be closely monitored by their obstetrician and their psychiatrist. The concern over the impact of the illness on their pregnancy and the potential effects of the medications on their child is paramount.
Risk Of Relapse
According to the National Alliance on Mental Health, women with either a personal history or a family history of bipolar disorder have an increased risk of experiencing an episode of bipolar disorder during the pregnancy and following childbirth. After experiencing one episode, the risk of an additional episode increases approximately 50% - 90%. The prevention of a relapse is a great concern for women with a history of bipolar disorder. When medications are discontinued during pregnancy without medical advice, the risk of a relapse is greatly increased.
Medications During Pregnancy
Managing bipolar disorder episodes typically involves medications, and their use during pregnancy is often a controversial topic between the expectant mother and her psychiatrist. Using medications during pregnancy is challenging as some bipolar disorder therapeutics may cause malformations in the fetus when used during the first three months of pregnancy. However, the risk of bipolar episodes may possibly increase during pregnancy.
Treatment For Bipolar Disorder During Pregnancy
The National Alliance of Mental Health references a review article from 2004 from the American Journal of Psychiatry which states that lithium and first generation antipsychotics such as Haldol and Thorazine are the preferred mood stabilizers for treating bipolar disorder during pregnancy because they have consistently shown to cause minimal risk to the fetus. Anticonvulsants such as Depakote or Tegretol have been shown to be harmful to a fetus and may contribute to birth defects. Studies through NAMI have revealed that introducing more than one mood stabilizer during pregnancy is more harmful than exposure to only one type of mood stabilizer. Details regarding specific medications for treating bipolar disorder and pregnancy are listed below.
Lithium - the majority of people with bipolar disorder rely on lithium as the primary medication for treatment and the choice to continue with the lithium treatment during pregnancy may be a life saving choice for the mother. Lithium has fewer risks to the fetus than other bipolar disorder medications and many pregnant women with this disorder switch to it before and during pregnancy because of the reduced risk to the fetus. When the expectant mother and her lithium medication are carefully monitored during pregnancy, delivery and following birth, the chances of relapse are lessened. Staying hydrated is crucial when taking lithium to prevent toxicity in the mother and/or the fetus.
Depakote - the use of Depakote during pregnancy has been proven to have harmful effects on the fetus. When a pregnant woman or a woman considering pregnancy is taking Depakote as part of the treatment plan for bipolar disorder, it is crucial that she be continuously monitored by her physician and psychiatrist throughout the pregnancy. A series of smaller does tends to be prescribed as opposed to one large dose which could be more harmful. While taking Depakote the majority of pregnant women are also prescribed vitamin K which may prevent conditions that can harm the child’s face and head.
Tegretol - the use of Tegretol for pregnant women with bipolar disorder is typically not prescribed unless there is no other option. Vitamin K is also prescribed for women who choose to continue to take Tegretol during pregnancy to help prevent damage to the mid-facial growth and to aid in the formation of correct blood clotting factors in the fetus.
The research concerning bipolar disorder and pregnancy is ongoing and women who are pregnant or planning a pregnancy should maintain a close relationship with their obstetrician and psychiatrists regarding the treatment best suited for them during their pregnancy.
NB: The content of this article is for information purposes only and is not intended to replace sound medical advice and opinion.
MGH Center for Women’s Mental Health: Bipolar and Pregnancy: Should Medications be discontinued? https://www.womensmentalhealth.org/posts/bipolar-disorder-and-pregnancy-should-medications-be-discontinued-2/
National Alliance on Mental Health: Managing Pregnancy and Bipolar Disorder https://www.nami.org/Template.cfm?Section=Bipolar_Disorder&template=/ContentManagement/ContentDisplay.cfm&ContentID=17899
(referenced through NAMI)Yonkers KA, Wisner KL, Stowe Z, Leibenluft E, Cohen L. & Miller L. et al. (2004). Management of bipolar disorder during pregnancy and the postpartum period. American Journal of Psychiatry, 161, 608-620.
Black Dog Institute: Treatments for Bipolar Disorder during pregnancy and the postnatal period. https://www.blackdoginstitute.org.au/docs/TreatmentsforBipolarDisorderduringpregnancyandthepostnatalperiod.pdf