Bipolar Disorder

Bipolar Disorder in Pregnancy

Do you have bipolar disorder and want to become pregnant? Or are you bipolar and pregnant already? If so, be sure to talk with your obstetrician and psychiatrist. With your doctors' help, you can carefully weigh the risks and benefits of bipolar medications. Learn how to keep your baby and yourself as healthy as you can. If you have bipolar disorder and become pregnant unexpectedly, take note: stopping your medications suddenly may cause harm to both you and your unborn child.

What if you are bipolar and not yet pregnant -- and choose not to be? Discuss forms of birth control with your doctor. For some women, it works best to use a contraceptive injection that is only needed every few months.

Complications of Bipolar Disorder in Pregnancy

There is no crystal clear roadmap for women who are bipolar and pregnant. That's because few studies have been done on bipolar disorder and pregnancy. Not enough is known about the risks of untreated bipolar disorder or the risks and benefits of medications. And the factors that lead to relapse during pregnancy are not entirely clear.

The symptoms of bipolar disorder, however, can worsen during pregnancy. Pregnant women or new mothers with bipolar disorder have seven times the risk of hospital admissions compared with pregnant women who do not have bipolar disorder.

A 2007 study on bipolar and pregnancy has shed further light. And it has called into question a common belief that pregnancy may have a protective effect for women with bipolar disorder. The study followed 89 women through pregnancy and one year after delivery. When stopping bipolar medications six months before conception to 12 weeks after, women had:

Twice the risk of relapse
A 50% risk of recurrence within just two weeks, if they stopped suddenly. (Women who had unplanned pregnancies were more likely to stop at once.)
Bipolar symptoms throughout 40% of the pregnancy -- or more than four times that experienced by women who continued their bipolar medications.

Bipolar Medications During Pregnancy

Some women continue taking bipolar medications and have healthy babies. But some bipolar medications cause an increased risk of birth defects in the first trimester, such as:

Neural tube defects
Heart defects
Developmental delay or neurobehavioral problems

However, you must weigh these risks against the risks of untreated bipolar disorder. It can lead to behaviors like these, which can also harm a baby:

Poor prenatal care
Poor nutrition
Increased use of alcohol or tobacco
Stress and trouble with attachment

Your doctor may suggest stopping gradually or changing medication. Or you may continue with medication and do regular tests to check on the health of your baby. But whatever you do, don't stop taking medications without first talking with your doctor.

Was your pregnancy unplanned? If so, know that the period of greatest concern may have already passed once you learned you were pregnant. Stopping medications suddenly may do more harm than good.

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Bipolar Medications During Pregnancy continued...

Mood stabilizers. Studies show that taking multiple mood-stabilizing medications is riskier than taking just one. Here's what is known: because of the risk for heart defects, lithium is not usually recommended during the first three months of pregnancy. But if you need a mood stabilizer, it may be a safer choice than others. And, when continued after childbirth, it can reduce the rate of relapse from 50% to 10%.

To reduce its risks to you and your child:

Drink plenty of water to prevent lithium toxicity.
Have lithium levels checked often -- in you and your child -- especially if you are breastfeeding.

Both valproate (Depakote) and carbamazepine (Tegretol) may lead to birth defects such as neural tube defects. And, most experts say it is a good idea to stop them during pregnancy. You may need to switch to another drug.

There is less information on the safety of newer anticonvulsants. However, lamotrigine (Lamictal) may be a useful alternative for some women.

Antipsychotic medications. Antipsychotic medications can be used during acute treatment of mania, especially to manage delusions or hallucinations. Examples of newer antipsychotics include:

aripiprazole (Abilify)
olanzapine (Zyprexa)
quetiapine (Seroquel)
risperidone (Risperdal)
ziprasidone (Geodon)

Your doctor may suggest that you switch during pregnancy to an older-generation antipsychotic such as haloperidol (Haldol). This may also be a good idea if you've stopped taking a mood stabilizer but experienced a recurrence of symptoms.

Antidepressants . There is less data about the effects of antidepressants on bipolar disorder and pregnancy. If you are on antidepressants, your doctors will watch you closely for mood switches or the acceleration of cycling. Also know that these drugs may increase the risk of mania. This is especially true if mood stabilizers have been stopped.

Electroconvulsive Therapy (ECT) During Pregnancy

Also known as electroshock, this therapy can have a therapeutic effect for mood disorders.Â During pregnancy, this type of therapy causes few complications. But to reduce the risks, your doctor may:

Have the baby's heart rate and oxygen levels monitored during ECT.
Suggest antacids or placement of an airway tube (intubation) to reduce the risk of gastric regurgitation or lung inflammation during ECT.
Encourage you to eat well and drink plenty of water to help prevent premature contractions.

Other Steps You Can Take

Do what you can to exercise and manage stress. And maintain structure in your day. These steps can all help you get good sleep and reduce rapid shifts in moods. As always, psychotherapy can also be a big help.