In arranging for being pregnant, gals with bipolar problem and their care suppliers are compelled to make hard alternatives. In the placing of medication discontinuation, relapse rates are important, and there is proof that untreated psychiatric health issues in the mother is affiliated with even worse maternal and fetal results. Having said that, several of the medications usually employed to handle bipolar condition, particularly lithium, have a tiny but measurable increase in chance of teratogenesis. The reproductive basic safety of other remedies, which includes atypical antipsychotic drugs, is not properly characterised. These selections are additional difficult by the paucity of data relating to the training course of bipolar health issues during being pregnant.
A current research from the United Kingdom appears to be particularly at recurrence of health issues during pregnancy and the postpartum period in a group of girls with bipolar disorder. This examine bundled 128 ladies with DSM-5 bipolar ailment (BD) who were being recruited to the Bipolar Disorder Study Network Being pregnant Research and had been followed from 12 weeks of gestation to 12 weeks postpartum. Semi-structured questionnaires, supplemented with clinician interviews and overview of the clinical document, had been used to assess for life time psychiatric background and psychiatric ailment all through being pregnant and the postpartum follow-up.
In this cohort, 98 women experienced bipolar I ailment/schizoaffective-BD (BD-I group) and 26 bipolar II disorder/other specified BD and similar disorder (BD-II team). The two groups have been similar, though the gals in the BD-II team experienced before onset of sickness and experienced much more recurrent depressive episodes than gals with BD-I. Data pertaining to the use of medications for the duration of pregnancy was not noted. About 40% of the women of all ages in each group applied a mood stabilizer in the course of the postpartum interval.
- Perinatal recurrence of sickness was popular in both teams: 57% (BD-I) and 62% (BD-II) seasoned a temper episode in the course of being pregnant.
- Women of all ages with BD-I were additional likely to knowledge mania/psychosis through pregnancy than women of all ages with BD-II (13.5% vs. %).
- Females with BD-I ended up additional probably to practical experience mania/psychosis within 6 months postpartum (23%) when compared to girls with BD-II (4%).
- In gals with BD-I, mania/psychosis through being pregnant was linked with a sevenfold improved danger 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.