The Challenge of Managing Bipolar Disorder During PregnancyManaging the monster that is bipolar disorder is essential. Managing prenatal care is literally vital. When combining the two, it’s a delicate battle. Making the choice to have children is an important process even when the parents are healthy. Choosing to have a child when you or your partner has a mental illness like bipolar disorder provides specific moral and practical challenges. You have to consider that bipolar disorder is highly hereditary, meaning there is a much higher chance that the child would also develop the disorder. Caring for kids is also difficult when you are also managing severe ups and downs. Then there is the pregnancy itself. For the health of both mother and baby, closely-monitored perinatal and postpartum care are essential.

Postpartum depression is a highly-recognized illness. About 15% of women experience it and because of the efforts by physicians and the media, the stigma surrounding it is slowly but surely dissipating. The same cannot be said for perinatal depression, which is often chalked up to “just pregnancy hormones” by friends and family. Recommended screening tools for mental illness during pregnancy have only been available to physicians for the past few years, although their use has become more and more prevalent.

Testing for bipolar disorder during pregnancy is rarely used even though more than 20% of those who screened positive for prenatal depression went on to be diagnosed with bipolar disorder.

This is a problem for a few reasons. First, not all women who are predisposed to bipolar disorder have developed the illness before becoming pregnant. There has to be a combination of factors, including genetics, that create bipolar disorder in a person. There is usually a life event that activates it. This can be any number of events: childhood abuse, the ending of a relationship, the death of a loved one and, yes, pregnancy. Even when pregnancy is a planned and happy event, it’s still stressful on the mind and body.

So, without a previous diagnosis, the development and symptoms of bipolar disorder during pregnancy can end up getting lost in the “it’s just pregnancy hormones” argument and left untreated.

Second, if someone tests positive and is treated for depression but not screened for bipolar disorder, the treatment can cause serious problems. Antidepressants can actually cause mania in some patients with bipolar disorder.

Even if bipolar disorder is detected during pregnancy or if the patient went into the pregnancy with a diagnosis and treatment, prenatal treatment is still very tricky.

Medications for bipolar disorder come with their own risks, especially during pregnancy. However, abstaining from drug therapy is not a guarantee that the baby won’t be negatively impacted. Bipolar disorder alone puts infants at risk of induced labor, cesarean section, microcephaly and low birth weight. For mom, symptoms tend to exacerbate significantly during the postpartum period if medication is not used at all.

Taking medication for bipolar disorder always comes with the risk for side effects for the patient. If a patient does decide to go ahead with medication use during pregnancy and breastfeeding, there are also increased risks for the baby. Some are extremely rare and some are temporary. They include:

Lithium

  • Cardiovascular malformations like Ebstein’s anomaly
  • Increased birth weight
  • Jaundice
  • Hypothyroidism
  • Diabetes

Mood Stabilizers

  • Spina bifida/anencephaly
  • Oral clefts
  • Growth retardation
  • Microcephaly
  • Heart defects

Valproate (in addition to risks of other mood stabilizers)

  • Congenital facial abnormalities
  • Heart rate deceleration
  • Withdrawal symptoms
  • Liver toxicity
  • Hypoglycemia

Antipsychotics

  • Dystonia/dyskinesia
  • Decreased/increased muscle tone
  • Breathing/feeding difficulties
  • Sedation
  • Agitation

Having an increased risk for problems associated with prenatal medication use does not mean that a child will automatically have these problems. It means that the chance is at least somewhat higher than for those who have not been exposed to the drugs.

The important thing is that you communicate with all of your doctors. This includes your primary care physician, psychiatrist and obstetrician. With bipolar disorder, pregnancy is considered high risk, so everyone needs to know what’s going on and be on the same page. Medications may need to be adjusted more frequently during pregnancy and if a patient chooses not to take medication during pregnancy, the dose has to be tapered down. Deciding how to go about treatment during pregnancy is a process. Just remember:

Never adjust your dosage or stop taking medication without talking to a doctor. It’s dangerous.

 

 

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