for some women though, giving birth will trigger their first bipolar episode. a person with bipolar disorder will experience extreme highs (mania) and lows (depression), which can continue for weeks and, in some cases, months. bipolar disorder has a lot to do with brain chemistry and there is a strong genetic link. the main treatment for bipolar disorder is medication.
for women who have been diagnosed with bipolar before they are pregnant it is a good idea to plan your pregnancy with the help of a doctor. your treatment must be a collaborative process between you, your partner and your treating gp or psychiatrist. you are at greatest risk of a bipolar relapse in the first month after delivery. for some women who have had recurrent episodes, you may choose to start or increase medication as soon as you deliver. women are encouraged to discuss their health needs with a health practitioner.
the period prevalence of bipolar disorders does not appear to differ significantly between pregnant and nonpregnant women,20,21 although some have reported lower prevalence rates of bipolar and other mood disorders during pregnancy than outside of pregnancy.20 still, episodes of mania or depression are thought to occur in an estimated 25%–30% of women with bipolar disorder during pregnancy.22,23 even higher rates of illness recurrence during pregnancy have been reported after stopping mood stabilizers (see ‘maintenance-phase treatment’ on page 4). additionally, many newer-generation anticonvulsants are sometimes used to treat patients with bipolar spectrum disorders in clinical practice (ie, gabapentin, topiramate, levetiracetam, etc), but have unproven benefit for acute or long-term treatment, and will not be reviewed either.29 a diagnosis of bipolar disorder has been associated with a slight but statistically significant increase in the risk of several pregnancy complications in observational studies. a subsequent prospective cohort study by the same group compared the risk of recurrence in 89 euthymic women with bipolar i or ii disorder who continued mood-stabilizer treatment during pregnancy or discontinued mood stabilizers during the time period beginning 6 months before and ending 12 weeks after conception.72 the risk of recurrence during pregnancy was 85.5% for women who discontinued mood stabilizers and 37.0% for those who continued mood-stabilizer treatment. it is also important to note that at least one other study has reported that lithium use during pregnancy was not associated with an increased incidence of large-for-gestational-age deliveries.108 lithium has not been clearly associated with adverse neurodevelopmental or neurobehavioral outcomes in offspring of women who received such treatment during pregnancy.109 it is unknown at present whether infants who develop the lithium neonatal adaptation syndrome are at greater risk for long-term neuropsychiatric, neurocognitive, or neurodevelopmental problems. most studies have shown greater adverse effects of valproate exposure on verbal abilities compared with nonverbal abilities.141–144 the magnitude of reduction in verbal iq associated with valproate has been shown to be dose-dependent.142,144 other studies have shown an association between in utero valproate exposure and worse neuromotor functioning in offspring of women with epilepsy.
antenatal administration of ect has not been consistently associated with adverse effects on pregnancy or neonatal outcome in pregnant women or neonates.198–200 sporadic cases of major malformations have been reported, with no clear pattern of malformations emerging.198 although data are limited, drugs that are commonly used for anesthesia (methohexital, propofol), neuromuscular blockade (succinylcholine), and prevention of clinically significant bradycardia during the stimulation phase of ect (glycopyrrolate) are not considered major human teratogens.201 low rates of fetal bradycardia were reported in a systematic review of 339 cases summarizing outcomes of ect administered during pregnancy.199 treating women with bipolar spectrum disorders during pregnancy is one of the greatest clinical challenges in psychiatric practice. recently documented increases in the use of mood-stabilizing anticonvulsants and atypical antipsychotics in pregnant women may reflect increased awareness of these risks among health care providers.25 on the other hand, a fifth to a third of women who remain on mood stabilizers may still relapse during pregnancy.66–68 continuation of pharmacotherapy with mood stabilizers during pregnancy, therefore, does not provide a guarantee against antepartum relapses. increased use of atypical antipsychotics during pregnancy24,25 appears to be accounted for primarily by pregnant women with diagnosed affective disorders, including bipolar disorder.24 on the other hand, the reproductive safety of atypical antipsychotics as a group and of individual agents is far less clear than that of most mood stabilizers. this is crucial for the conduct of studies of drug exposure in pregnant women with bipolar disorder and other affective disorders, because many women stop medications due to fears of teratogenic risk.203 these limitations may be partially addressed by the use of drug- and disease-specific pregnancy registries. risks to both mother and baby are imposed by untreated or under-treated bipolar illness and by the use of pharmacotherapy.
bipolar disorder, however, can worsen during pregnancy. pregnant women or new mothers with bipolar disorder have seven times the risk of for women who have been diagnosed with bipolar before they are pregnant it is a good idea to plan your pregnancy with the help of a doctor. some medications 20 still, episodes of mania or depression are thought to occur in an estimated 25%–30% of women with bipolar disorder during pregnancy.22,23, .
it’s not clear how bipolar disorder itself can affect fetal development. there’s a chance that bd may be passed on to your child, but this isn’t “bipolar disorder comes with its own unique challenges that include mood swings as a result of hormonal fluctuations during pregnancy,” shared some medications used to treat bipolar disorder carry risks when you are pregnant or breastfeeding. but some women will still need to take their medication, .
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