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.
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:
Your doctor may suggest stopping some medicines but continuing others, because, for some women, the mental health risks of stopping a medication are greater than the possible (or unknown) risks -- if any -- of continuing it. Psychiatrists with expertise in women's health often advise continuing certain psychiatric medicines during pregnancy along with 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 can carry 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%.
To reduce its risks to you and your child:
- Drink plenty of water and maintain normal salt intake to prevent lithium toxicity.
- Have your lithium levels checked regularly.
- If you choose to breastfeed while taking lithium, make sure your pediatrician is checking your baby's levels of lithium, thyroid hormone, and kidney function after delivery, at 4-6 weeks of age, and then every 8-12 weeks.
Both valproate (Depakote) and carbamazepine (Tegretol) during the first trimester may lead to birth defects such as neural tube defects, affecting the formation of the brain and spinal cord (for this reason, it is crucial to take the proper prenatal vitamins, including folic acid).And most experts say it is a good idea to stop them at least during the first trimester of pregnancy. You may need to switch to another drug.
Antipsychotic medications. Antipsychotic medications can be used during acute treatment of mania, especially to manage delusions or hallucinations. Some medicines in this family also have become standard first-line treatments for acute bipolar depression. Examples of newer antipsychotics include:
Your doctor may suggest that you switch during pregnancy to an older-generation antipsychotic such as haloperidol (Haldol). This may also be a good idea if you've stopped taking a mood stabilizer but symptoms came back.
Antidepressants. There is less information about the effects of antidepressants on bipolar disorder and pregnancy. If you are on antidepressants, your doctors will watch you closely for mood switches or multiple episodes over time. Also, know that these drugs may increase the risk of mania. This is thought to be especially true if mood stabilizers have been stopped.
Electroconvulsive Therapy (ECT) During Pregnancy
Also known as electroshock, this therapy is among the safest treatment options during pregnancy and can have a therapeutic effect for mood disorders. During pregnancy, this type of therapy causes few complications. But to reduce the risks, your doctor may:
- Have the baby's heart rate and oxygen levels monitored during ECT.
- Suggest antacids or placement of an airway tube (intubation) to reduce the risk of gastric regurgitation or lung inflammation during ECT.
- Encourage you to eat well and drink plenty of water to help prevent premature contractions.
Other Steps You Can Take
Do what you can to exercise and manage stress. And maintain structure in your day. These steps can help you get good sleep and reduce rapid shifts in moods. As always, psychotherapy can also be a big help.