December 5, 2007

A New Study on the Effects of Pregnancy on Bipolar Disorder

A new study published in this month's issue of the American Journal of Psychiatry, examined three groups of pregnant women suffering from bipolar disorder. The goal of the study was to examine the course of bipolar disorder during pregnancy.

Past studies have demonstrated that mothers suffering from bipolar disorder are at an increased risk for relapse during the postpartum period, i.e., the period of time immediately following childbirth. This risk has been shown to be higher for women (suffering from bipolar disorder) who aren't on mood stabilizers while pregnant, as compared to women who are on mood stabilizers while pregnant. Unfortunately, the issue of being on medication while pregnant is a complicated one for women who suffer from bipolar disorder. On the one hand, there are known risks for the fetus associated with medication. According to the study, some of these teratogenic risks include neural tube defects associated with the mood stabilizers valproate and carbamazepine, as well as, an increased risk for cardiovascular malformations--the authors of the study provide an example of this: Ebstein's anomaly--associated with lithium. On the other hand, abrupt cessation of medication for people suffering from bipolar disorder, particularly pregnant women, can be extremely harmful to the sufferer, and in the case of pregnant women, also to the fetus.

The study focused on three groups of a total of 89 women who suffered from bipolar disorder and who were in the process of planning for pregnancy. The participants were:

seeking psychiatric consultation in a specialized perinatal psychiatry program. Pregnant women were enrolled prior to 24 weeks gestation and included if they 1) were euthymic for at least 1 month prior to conception, 2) were receiving treatment with a mood stabilizer, or 3) had discontinued pharmacotherapy at least 6 months prior to pregnancy or within the first trimester. Women were followed through pregnancy and the postpartum year, and patients decided themselves whether to continue or discontinue medication. A majority of women experienced at least one mood episode during pregnancy (70.8%). The risk of recurrence was significantly higher in women who discontinued treatment with mood stabilizers. Women who discontinued medication also spent more time ill during pregnancy compared with women who continued medication. Several history of illness and treatment factors were associated with relapse during pregnancy. One of the treatment factors associated with increased relapse rates was rapid mood stabilizer discontinuation. The only pregnancy-related predictor of relapse was if the pregnancy was unplanned.

The researchers bring up the important point with regards to these results that most psychiatrists and other mental health professionals treating female sufferers of bipolar disorder don't consider the probability of pregnancy for their patients. Thus when pregnancy does occur, both patient and mental health professional, surprised and unequipped with preparation panic, which sometimes results in abrupt discontinuation of meds for the patient. The problem with this is, as the researchers point out, and the study's results demonstrate, pregnant women suffering from bipolar disorder are more likely to have unhealthy pregnancies and postpartum periods if their meds are abruptly discontinued. Another point the researchers make is that the risks for the fetus associated with most medications used to treat bipolar disorder are concentrated around the first trimester, when most women don't know that they are pregnant. So cessation of medication may not occur until the second trimester, when this increased risk is much less severe.

There is no clear-cut solution to this problem. For now, the researchers encourage that both sufferers and treatment professionals be aware that a large number of bipolar patients are women in their reproductive years, thus the probability of pregnancy is likely. The researchers also stress the importance of discussing a possible pregnancy with your mental health professional as soon as possible and coming up with a plan of dealing with both the pregnancy and the illness as a combined effort between patient and practitioner.

See This Editorial: Bipolar Disorder and Pregnancy: Risks Revealed (American Journal of Psychiatry)

Related Reading:
Valproate Used During Pregnancy Linked To Lower IQ in Children
Bipolar Drug Lamictal Tied to Birth Defects
Treatment Considerations in Reproductive Health
Postpartum Depression in Bipolar Disorder

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