Women With Bipolar Disorder
Treatment During Pregnancy continued...
Some drugs, such as valproic acid and carbamazepine, have been shown to be harmful to babies and contribute to birth defects. If a woman taking valproic acid discovers she is pregnant, her doctor may change her medication or adjust the dosage and prescribe folic acid to help prevent birth defects affecting the development of baby's brain and spinal cord.
Most experts avoid carbamazepine during pregnancy unless there are no other options. Carbamazepine not only poses risks to the unborn baby, but can also cause complications such as a rare blood disorder and liver failure in the mother, particularly if begun after conception.
Some drugs taken in late pregnancy may cause the baby to experience abnormal muscle movements, called extrapyramidal signs (EPS), or withdrawal symptoms at birth. The drugs include Abilify (aripiprazole), Haldol (haloperidol), Risperdal (risperidone), Seroquel (quetiapine), and Zyprexa (olanzapine).
The symptoms for the baby may include:
- abnormally increased or decreased muscle tone
- difficulty breathing and feeding
- involuntary muscle contractions or twitching
In some babies, these symptoms go away within hours or days on their own. Other babies may need to stay in the hospital for monitoring or treatment.
In general, doctors try to limit the amount of medications a developing baby is exposed to during pregnancy. That is because even among drugs that have no known risk to the fetus, there are always unknown risks, which can be minimized by keeping an existing medicine whenever possible rather than adding new ones.
Other Treatment Considerations for Women
Girls and young women who are taking valproic acid should see their doctors regularly for monitoring. That's because the drug may increase levels of the male hormone testosterone and lead to polycystic ovary syndrome (PCOS). PCOS is a condition that affects the ovaries and leads to obesity, excess body hair, and irregular menstrual cycles.
The use of lithium may lead to low levels of thyroid hormone in some people, which can affect symptoms of bipolar disorder. If thyroid hormone is low, thyroid hormone medication is needed. Other side effects include:
For women who prefer to avoid medications, electroconvulsive therapy (ECT) may provide a safer option for their unborn babies. During ECT, doctors monitor the baby's heart rate and oxygen levels for potential problems, which can be treated if necessary.
Pregnant women and women in the postpartum period who have bipolar disorder may also benefit from:
- stress management
- regular exercise
For women who are considering having a baby, it is important to work with their doctors well before conceiving to develop the best treatment during conception, pregnancy, and new motherhood. Because unplanned pregnancies can occur, all women of childbearing potential should speak to their doctors about managing bipolar disorder during pregnancy, regardless of their plans for motherhood.