In scheduling for pregnancy, gals with bipolar ailment and their treatment vendors are compelled to make hard alternatives. In the setting of treatment discontinuation, relapse fees are important, and there is evidence that untreated psychiatric ailment in the mom is related with even worse maternal and fetal results. Nevertheless, several of the prescription drugs typically applied to deal with bipolar dysfunction, specifically lithium, have a smaller but measurable enhance in possibility of teratogenesis. The reproductive safety of other remedies, such as atypical antipsychotic medicines, is not properly characterised. These decisions are further intricate by the paucity of info about the course of bipolar disease in the course of pregnancy.
A latest analyze from the United Kingdom looks especially at recurrence of disease during pregnancy and the postpartum period in a team of gals with bipolar condition. This examine involved 128 girls with DSM-5 bipolar dysfunction (BD) who ended up recruited to the Bipolar Dysfunction Analysis Network Pregnancy Analyze and were followed from 12 months of gestation to 12 weeks postpartum. Semi-structured questionnaires, supplemented with clinician interviews and overview of the clinical report, were utilized to assess for life span psychiatric heritage and psychiatric disease all through pregnancy and the postpartum adhere to-up.
In this cohort, 98 females had bipolar I problem/schizoaffective-BD (BD-I team) and 26 bipolar II disorder/other specified BD and related dysfunction (BD-II group). The two groups were being related, while the women of all ages in the BD-II team had earlier onset of health issues and had additional regular depressive episodes than gals with BD-I. Information and facts concerning the use of drugs all through being pregnant was not claimed. About 40% of the females in each group used a mood stabilizer in the course of the postpartum period of time.
- Perinatal recurrence of illness was common in both equally teams: 57% (BD-I) and 62% (BD-II) expert a mood episode throughout being pregnant.
- Females with BD-I were being a lot more probably to encounter mania/psychosis all through being pregnant than females with BD-II (13.5% vs. %).
- Females with BD-I have been much more possible to knowledge mania/psychosis inside of 6 months postpartum (23%) as opposed to ladies with BD-II (4%).
- In ladies with BD-I, mania/psychosis throughout being pregnant was involved with a sevenfold improved possibility of postpartum mania/psychosis (RR 7., p<0.001).
In women with BD-I, depression during pregnancy was associated with a threefold increase in risk of postpartum depression (RR 3.18, p=0.023).
This study is consistent with previous reports suggesting that risk for perinatal recurrence of bipolar disorder is high, with approximately 60% of women with bipolar disorder (type I or II) experiencing recurrent illness during pregnancy and/or the postpartum period. Also consistent with previous reports is the finding that depressive episodes are more common than mania in women with BD-I and BD-II however, mania/psychosis is much more common in women with BD-I than those with BD-II. (In this study, only one of the 26 women with BD-II experienced postpartum mania/psychosis.)
The Importance of Remaining Well During Pregnancy
Of great clinical significance is the observation that women who experience recurrent illness during pregnancy are more likely to experience illness during the postpartum period. The highest risk was observed in women with BD-I in this study, women who experienced mania/psychosis during pregnancy had a sevenfold increased risk of experiencing postpartum mania/psychosis. Overall, recurrence of illness during pregnancy (depression or mania) was associated with a twofold increase in risk for postpartum illness.
It is clear that risk for postpartum psychiatric illness, including postpartum psychosis, is high in women with bipolar disorder. Previous studies have demonstrated that risk for postpartum illness can be reduced significantly with the use of a mood stabilizer, such as lithium, during the postpartum period. However, given the risks associated with the use of certain mood stabilizers during pregnancy, many women and their providers elect to discontinue mood stabilizers during pregnancy. This study confirms previous studies documenting high rates of recurrent illness during pregnancy in women with bipolar disorder, but the findings of this study also suggest that the discontinuation of mood stabilizers during pregnancy may have significant implications for vulnerability to postpartum psychiatric illness.
In women with unipolar depression, relapse during pregnancy is a robust predictor of postpartum depression this study indicates that for women with bipolar disorder, recurrent illness during pregnancy, especially mania or psychosis, is a robust predictor of postpartum psychiatric illness. While certain mood stabilizers, including lithium carry some risk of teratogenesis, we need to weigh the relatively small risk of teratogenesis in mood stabilizers, excluding valproic acid, against the very high risk of recurrent illness during pregnancy in the mother. Avoiding medication during pregnancy and restarting it after delivery may not be the best option. This study, and others, suggests that keeping the mother well during pregnancy will reduce the risk of postpartum psychiatric illness.
Ruta Nonacs, MD PhD
Perry A, Gordon-Smith K, Di Florio A, Craddock N, Jones L, Jones I. Mood episodes in pregnancy and risk of postpartum recurrence in bipolar disorder: The Bipolar Disorder Research Network Pregnancy Study. J Affect Disord. 2021294:714-722.