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Bipolar Disorder in Pregnancy

Do you have bipolar disorder and want to become pregnant or are pregnant already? Perhaps you have bipolar disorder and do not want a pregnancy. Be sure to talk with both your obstetrician and psychiatrist about the risks and benefits of bipolar medications and forms of birth control. For some women, a contraceptive injection that is only needed every few months is best.  

If you have bipolar disorder and become pregnant unexpectedly, take note: Stopping your medications suddenly may cause harm to you and your unborn child.


Complications of Bipolar Disorder in Pregnancy

Few studies have been done on bipolar disorder and pregnancy, so not enough is known about the risks of untreated bipolar disorder or the risks and benefits of medications during pregnancy. And the factors that lead to relapse during pregnancy are not clear.

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

At least one study has called into question the common belief that pregnancy may have a protective effect for women with bipolar disorder. The study followed 89 women through pregnancy and the year after delivery. When stopping bipolar medications for the period from six months before conception to12 weeks after, the women had:

  • Twice the risk of relapse
  • A 50% risk of recurrence within just two weeks, if they stopped suddenly
  • Bipolar symptoms throughout 40% of the pregnancy -- or more than four times that of women who continued their bipolar medications.


Bipolar Medications During Pregnancy

Some women continue taking bipolar medications and have healthy babies. But a few bipolar medications have an increased risk of birth defects in the first trimester. That includes defects 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. 

Untreated depression, for example, has been linked in some studies with low birth weight, or possible negative effects on developing brain structures in the baby. Mood symptoms  can also lead to behaviors like these, which can harm a baby:

  • Poor prenatal care
  • Poor nutrition
  • A rise in alcohol or tobacco use
  • 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 stopping medications suddenly may do more harm than good.

Mood stabilizers. Taking multiple mood-stabilizing drugs has more risks than taking just one. Because of the rare risk for a particular kind of heart defect, lithium is sometimes not recommended during the first three months of pregnancy unless its benefits clearly outweigh the risks. Lithium may, though, be a safer choice than some anticonvulsants. And when lithium is continued after childbirth, it can reduce the rate of relapse from 50% to 10%.

WebMD Medical Reference

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