How to Manage Bipolar Disorder During Pregnancy?

Bipolar disorder is a chronic mental health condition that is difficult to treat. There is also no cure for this condition, and people with this illness need to be on a lifelong treatment protocol depending on the severity of their symptoms. People with bipolar disorder tend to have extreme mood shifts that include low or depressive episodes and manic or high episodes. People who have bipolar disorder are usually hesitant about experiencing any significant life changes, such as being pregnant. However, having bipolar disorder does not mean that you cannot have a baby.

Here are all the things to know about bipolar disorder and pregnancy.

Overview of Bipolar Disorder

Characterized by extreme moods, bipolar disorder is a chronic mental health condition that affects nearly 2.8 percent of adults in the United States alone. (1) The number is likely to be higher, considering the number of people who remain undiagnosed. It is believed that the average age when people usually get diagnosed with this disorder is 25 years. (2) Bipolar disorder was earlier known as manic depressive disorder, but since then, the name has been changed to better reflect the full range of moods a person with this illness goes through. (3) Sometimes, people with bipolar disorder can experience both mania and depression symptoms at the same time. (4,5)

People with bipolar disorder experience extreme mood swings, from mania to depression. This is a very serious mental health condition that can lead to even suicidal tendencies. While there is no cure for bipolar, it can be managed with therapy and medications.

Pregnancy and Bipolar Disorder

People with bipolar disorder are often incredibly hesitant about experiencing any major life changes, such as pregnancy. However, just because you have bipolar disorder, it does not mean that you can’t, or you should not have a baby. Nevertheless, it does mean that you need to weigh the pros and cons of a potential pregnancy very seriously and discuss your options with your doctor and partner.

If you have bipolar disorder and you want to get pregnant, then you have to work with your doctor to consider your overall well-being as well as the following facts:

  • What medications are you currently taking, and will they affect the growing baby once you are pregnant?
  • How severe are your symptoms?
  • How well managed is your bipolar disorder?
  • Are you having any suicidal thoughts or thoughts about hurting yourself or the baby?

For people with bipolar disorder, the potential risk to the baby also has to be weighed in before you start planning for a pregnancy. (6)

Mental Health and Pregnancy

It is essential to keep in mind that any pregnancy is going to lead to several types of hormonal changes in the body that may have a direct impact on your mood. While on certain days you may feel very happy, other days might find you feeling miserable and down. The symptoms of bipolar disorder are also likely to become more pronounced during your pregnancy. This is true not just for bipolar disorder, but for other types of mental health disorders as well.

During pregnancy, women who have mental health issues are likely to find that their mood fluctuates more than usual. The risk is even higher if you have bipolar disorder, and it is left untreated during pregnancy. (7)

How to Manage Bipolar Disorder During Pregnancy?

One of the biggest concerns if you have bipolar disorder and are pregnant is the medications you are likely to take to manage your condition. For example, mood stabilizers such as lithium (brand name: Eskalith) or divalproex sodium (brand name: Depakote) are known to be dangerous to a developing baby. (8,9) While the exact effects of these medications remain unclear, studies have, however, shown that lithium, when taken during the first trimester of pregnancy, increases the risk of cardiac malformations in a growing fetus. (10) The same study also found that out of the 663 infants who were exposed to the lithium drug, only 16 were found to have such cardiac malformations.

A review of studies found that taking valproate during pregnancy increases the risk of neurological defects in babies. In some cases, these defects resolved themselves by 12 months of age. The reviewing authors found that the data they had accessed was of low quality and, therefore, concluded an urgent need for additional studies on valproate and its impact on infants. (11)

The overall consensus between medical experts and researchers is that more studies need to be carried out to support these findings. Still, the bottom line remains that the medications taken for managing the symptoms of bipolar disorder are likely to have an impact on fetal development. Some of the other medicines used in treating bipolar disorder are also likely to harm the developing fetus, including some:

  1. Antipsychotics
  2. Antidepressants
  3. Anti-anxiety drugs

In order to prevent complications with your baby, you need to let your obstetrician know about all the bipolar medications you are taking. Your doctor and your obstetrician may decide to stop or lower your medications during your pregnancy, during which time you will have to rely on other forms of treatment for managing your bipolar disorder, such as psychotherapy and self-care. Continuing with bipolar treatment during pregnancy may lower the risk of relapse after giving birth. However, the decision has to be taken by you and your medical team by weighing the benefits and the risks of stopping the medications during pregnancy. (12)

There is a lack of in-depth studies showing how bipolar disorder affects the development of a fetus. There is a likelihood that bipolar disorder may also be passed on to your child, but this is usually not an immediate cause of concern during the pregnancy. Scientists are still researching the exact genetic nature of bipolar disorder. (13,14)

Bipolar Disorder and the Postpartum Period

Apart from concerns during pregnancy, there could be some risks for a mother and a child’s well-being right after labor and delivery. Bipolar disorder is known to increase the risk of postpartum psychosis. (15) Often, the symptoms of postpartum psychosis are confused as being postpartum depression, which is another common mental health condition that many women experience after delivery. You may experience postpartum depressions regardless of whether you have bipolar disorder or not.

Postpartum psychosis, though, is a rare, but potentially serious and dangerous condition that needs emergency treatment. It is known to affect 1 in every 1000 women who give birth. Symptoms of postpartum psychosis include severe depression or mania, which begins within two to three days post-delivery. Delusions and hallucinations also commonly accompany postpartum psychosis. (16)

Breastfeeding may also pose certain challenges for mothers who have bipolar disorder. Firstly, there is a concern about the medications getting transmitted from the mother to the baby through breast milk. While some of the newer antidepressants do not pose such risks, antipsychotic medications can prove to be dangerous in such a scenario. Breastfeeding is also likely to disrupt the sleep cycle of a new mother with bipolar disorder. Getting proper sleep is very important in preventing a relapse of bipolar disease. (17)

Conclusion

If you have bipolar disorder and you want to get pregnant, then it is best to plan a pregnancy well ahead of time and keep your doctor informed about your decision. Having your doctor on board your plan makes it easier for you to develop a plan to help keep you and the baby safe during the pregnancy and postpartum period. Your doctor will advise you on switching medications, stopping the medications altogether, what nutritional supplements you should be taking, along with self-care tips such as getting adequate sleep.

There are many health considerations that are involved for any woman with bipolar disorder to plan a pregnancy. While it is safe for people with bipolar disorder to have a baby, but you should try to plan things ahead as much as possible. Under no circumstance, though, should you stop taking your medications without consulting your doctor.

References:

  1. Nimh.nih.gov. 2020. NIMH » Bipolar Disorder. [online] Available at: <https://www.nimh.nih.gov/health/statistics/bipolar-disorder.shtml> [Accessed 26 July 2020].
  2. Nami.org. 2020. Mental Health By The Numbers | NAMI: National Alliance On Mental Illness. [online] Available at: <https://www.nami.org/mhstats> [Accessed 25 July 2020].
  3. Gardner, R., 1982. Mechanisms in manic-depressive disorder: an evolutionary model. Archives of General Psychiatry, 39(12), pp.1436-1441. Miklowitz, D.J. and Johnson, S.L., 2008. Bipolar disorder. John Wiley & Sons Inc.
  4. Müller-Oerlinghausen, B., Berghöfer, A. and Bauer, M., 2002. Bipolar disorder. The Lancet, 359(9302), pp.241-247.
  5. Viguera, A.C., Cohen, L.S., Baldessarini, R.J. and Nonacs, R., 2002. Managing bipolar disorder during pregnancy: weighing the risks and benefits. The Canadian Journal of Psychiatry, 47(5), pp.426-436.
  6. Makregiorgos, H., Joubert, L. and Epstein, I., 2013. Maternal mental health: Pathways of care for women experiencing mental health issues during pregnancy. Social work in health care, 52(2-3), pp.258-279.
  7. Malhi, G.S., Tanious, M., Das, P., Coulston, C.M. and Berk, M., 2013. Potential mechanisms of action of lithium in bipolar disorder. CNS drugs, 27(2), pp.135-153.
  8. Hollander, E., Dolgoff-Kaspar, R., Cartwright, C., Rawitt, R. and Novotny, S., 2001. An open trial of divalproex sodium in autism spectrum disorders. The Journal of clinical psychiatry.
  9. Patorno, E., Huybrechts, K.F., Bateman, B.T., Cohen, J.M., Desai, R.J., Mogun, H., Cohen, L.S. and Hernandez-Diaz, S., 2017. Lithium use in pregnancy and the risk of cardiac malformations. New England Journal of Medicine, 376(23), pp.2245-2254.
  10. Haskey, C. and Galbally, M., 2017. Mood stabilizers in pregnancy and child developmental outcomes: a systematic review. Australian & New Zealand Journal of Psychiatry, 51(11), pp.1087-1097.
  11. Newport, D.J., Stowe, Z.N., Viguera, A.C., Calamaras, M.R., Juric, S., Knight, B., Pennell, P.B. and Baldessarini, R.J., 2008. Lamotrigine in bipolar disorder: efficacy during pregnancy. Bipolar disorders, 10(3), pp.432-436.
  12. Craddock, N. and Jones, I., 1999. Genetics of bipolar disorder. Journal of medical genetics, 36(8), pp.585-594.
  13. Craddock, N. and Sklar, P., 2013. Genetics of bipolar disorder. The Lancet, 381(9878), pp.1654-1662.
  14. Jones, S.C. and Jones, I., 2017. Pharmacological management of bipolar disorder in pregnancy. CNS drugs, 31(9), pp.737-745.
  15. Health, M., Health, M., Health, M., Health, M., Health, M., Health, M. and Health, M., 2020. Postpartum Psychiatric Disorders – MGH Center For Women’s Mental Health. [online] MGH Center for Women’s Mental Health. Available at: <https://womensmentalhealth.org/specialty-clinics/postpartum-psychiatric-disorders/?doing_wp_cron=1507537973.4586529731750488281250> [Accessed 28 July 2020].
  16. Harvey, A.G., 2008. Sleep and circadian rhythms in bipolar disorder: seeking synchrony, harmony, and regulation. American journal of psychiatry, 165(7), pp.820-829.

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