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Research provides recommended approaches for treating bipolar disorder during pregnancy

When treating bipolar disorder during pregnancy, researchers recommend clinicians consider the importance of maintaining treatment and avoiding relapse with the risks of medications.

“Approximately 60% to 70% of women with bipolar disorder will experience a mood episode during pregnancy and/or the postpartum period. Of women with bipolar disorder, 25% to 30% will experience an episode of depression or mania during the postpartum period,” Leena Mittal, MD, FAPM, of Harvard Medical School, and colleagues wrote. “Given the tenuous nature of this illness during pregnancy, it is essential that psychiatric providers consider treatment options during pregnancy when treating any woman of reproductive age.”

Reproductive events including menarche, pregnancy, postpartum and the menopausal transition, may increase risk for mood episodes and discontinuing medication increases risk for recurrence of bipolar disorder symptoms, according to researchers.

“Women who discontinue medication during pregnancy are at greater risk of decompensation during the postpartum period than those women who discontinue medication outside of pregnancy. In addition, the rate of recurrence of symptoms is more rapid after abrupt discontinuation as compared to gradual discontinuation,” Mittal and colleagues wrote.

However, in-utero exposure to psychiatric medications may pose risks for children.

Mittal and colleagues explored risks and benefits associated with lithium, valproate, carbamazepine, lamotrigine and first and second-generation antipsychotics.

“In general, the approach to treatment in anticipation of or during pregnancy and breast-feeding involves maximizing effective treatment while minimizing unnecessary exposure to medications during pregnancy. Thus, agents known to be effective for an individual should be chosen preferentially during pregnancy. Priority should be given to adequate mood stabilization during pregnancy to assure prophylaxis against postpartum psychosis,” they wrote.

When women with bipolar disorder are planning a pregnancy, non-pharmacological treatments, such as sharing newborn care and feeding responsibilities with a partner, family member or hired professional, should be considered to ease the transition into parenthood and reduce the demands of newborn care.

Mittal and colleagues also addressed breast-feeding and bipolar disorder, particularly the presence of medication in breastmilk.

The American Academy of Pediatrics recommends medications present in breast-milk have levels lower than 10%, and researchers report most mood stabilizers have low amounts sufficient to be considered safe for breast-feeding, except for lithium and lamotrigine.

“Discussions about treatment during pregnancy should take place prior to pregnancy whenever possible. Medications should not simply be stopped when a woman finds out she is pregnant, as many mood stabilizing medications are reasonable choices for use during pregnancy,” Mittal and colleagues wrote. “Coordination of care and communication between psychiatric and obstetric/gynecologic providers can facilitate thoughtful planning and management during and after pregnancy.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.