Here is a summary of how medication for bipolar mood disorder affects a woman’s pregnancy, including the effects on the baby and the effectiveness of the prescription that controls mood swings.
Approximately 4.4 million women in the U.S. have bipolar disorder, with women of childbearing age having the highest prevalence. Bipolar disorder (sometimes called manic depression) is a serious, long term condition involving extreme mood swings. Treatment with mood stabilising drugs like lithium, anticonvulsants or antipsychotics can help keep mood within normal limits.
First, the bad news:
“The safety of the fetus is at risk [when a pregnant woman has bipolar mood disorder],” says Crystal Clark, M.D., an assistant professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine and a psychiatrist at Northwestern Memorial Hospital. “Pregnant women who are depressed are less likely to take care of themselves which often leads to poor nutrition, lack of compliance with prenatal care and isolation from family and friends. It has also been linked to premature births and babies with low birth weights among other poor birth outcomes.” Dr Clark is the lead investigator of the first study mentioned below.
The good news is doctors and pregnant women are becoming aware of how pregnancy affects bipolar mood disorder, which means unborn babies will be protected and healthy. In this article, I summarize two recent research studies on bipolar mood disorder and pregnancy: the first is from Northwestern Medicine® research, called Bipolar and Pregnant. The second is from Sweden, called Pregnancy and Birth Complications More Likely in Mothers With Bipolar Disorder.
Bipolar Mood Disorder and Pregnancy
Bipolar drugs lose effect when a woman is pregnant, so she needs higher doses to stay well. This study by Northwestern Medicine® is one of the first to research how physiological changes during pregnancy affect a commonly used drug (lamotrigine) to treat bipolar disorder. If the prescription medication is less effective, women are more vulnerable to recurring episodes of bipolar mood swings.
When a woman with bipolar disorder becomes pregnant, she and her physician often don’t realize her medication needs to be adjusted to prevent the symptoms and mood swings from coming back. The symptoms of bipolar mood disorder are at a higher risk during pregnancy. Unfortunately, there isn’t very much information or research to guide doctors and pregnant women in terms of dosing for bipolar mood disorder during pregnancy.
This research on bipolar mood disorder and pregnancy shows the blood concentration of the commonly used drug lamotrigine decreases in pregnant women. About half of the women in the study had worsening depressive symptoms as their lamotrigine blood levels dropped. The drug levels fall because women have increased metabolism during pregnancy.
Doctors need to optimize a woman’s medication for bipolar mood disorder, so she stays healthy and stable during her pregnancy. This study will help doctors understand how to increase their patients’ doses during pregnancy and then reduce the medications after the baby is born (postpartum), to avoid toxicity.
Source: Bipolar and Pregnant via Northwestern Medicine. The study was published in the American Journal of Psychiatry.
Bipolar Mood Disorder and Pregnancy
Researchers from Uppsala University and the Karolinska Institutet in Sweden investigated the risks of pregnancy and birth outcomes in both treated and untreated women with bipolar disorder. They found that depressive episodes – as opposed to manic – are most likely to recur in pregnant women with bipolar disorder.
Babies born to mothers with bipolar disorder are at increased risk of preterm birth (before 37 weeks) a study published today on bmj.com suggests. Infants of mothers with untreated bipolar disorder are also at increased risks of outcomes related to fetal growth restriction.
Previous studies on pregnancy and bipolar mood disorder suggested that prescription medications may be linked to pregnancy and birth complications, whereas little is known about adverse outcomes in untreated women with bipolar disorder. In this study, mothers with bipolar disorder were more often smokers, overweight and alcohol or substance abusers than women without bipolar.
The researchers conclude that “mood-stabilising treatment is probably not the sole reason for the increased risk of adverse pregnancy and birth outcomes previously observed in mothers with bipolar disorder.” They also suggest that the role of treatment is still unclear as the overall outcomes “generally did not support a significant difference between untreated and treated” mothers.
Both treated and untreated pregnant women with bipolar disorder had increased risks of caesarean delivery, instrumental delivery (use of a vacuum or forceps), and a non-spontaneous start to delivery. Treated and untreated mothers also had 50% increased risks of preterm birth compared with unaffected mothers. Untreated mothers were also more likely to give birth to a baby with a small head (microcephaly) and with episodes of low blood sugar levels (neonatal hypoglycaemia) compared with unaffected mothers.
In an accompanying editorial, mental health expert Dr Salvatore Gentile says the question is not “to treat or not to treat?” Rather, the issue with pregnancy and bipolar mood disorder is “how to treat bipolar optimally?” No prescription drug for bipolar mood disorder is without risks for pregnancy, so clinicians cannot hope to identify a safe choice but merely a less harmful one.
If you have bipolar and are pregnant (or want to get pregnant), talk to your doctor about how your prescription will affect both your baby’s and your health.
Pregnant women must be properly counselled about the risks of treatment versus the risks associated with untreated bipolar mood disorder. Further, doctors should encourage and facilitate social integration, especially for women from disadvantaged social groups and those who are isolated.
You may also find 10 Tips for a Healthy Pregnancy From a Certified Nurse Midwife helpful.