The decision to have a child is not one that should be made lightly by anyone. Those with chronic illnesses have more to consider in the decision than the average person. Bipolar disorder comes with its own set of challenges. It’s difficult enough to manage even when it can be the first priority. There are medications to be managed and mood shifts to navigate. It is also imperative to have a routine. All of these are complicated by pregnancy and child rearing. A new study highlights four specific concerns women considering having children have about doing so while managing bipolar disorder.
The research, led by Anja Wilhelmina Margaretha Maria Stevens of the VU University Medical Center, Amsterdam, interviewed 15 women regarding their concerns with family planning. Ten of these women expressed the desire to have children. Five had decided they wanted children. One had made the decision not to have children and four were still in doubt about the decision.
During the interviews about their concerns and considerations about having children, the researchers found four topics that were especially common.
Most participants were concerned about whether or not they would pass their bipolar disorder onto their child. This is a legitimate concern. Bipolar disorder has relatively high heritability. There is an approximately 10% chance that a child will inherit bipolar disorder if one parent has it. That chance jumps to 40% if both parents do. One participant wondered if it might be selfish to take the chance of passing a burdensome disorder onto a child.
Using medication during pregnancy can be risky. Many bipolar disorder medications have the potential to cause serious birth defects including cardiovascular abnormalities, hypothyroidism, diabetes and growth retardation, among others. However, with close monitoring, most mood stabilizers can be used safely during pregnancy, even lithium. Even antipsychotics may not cause problems when used early in the pregnancy. Going without medication can also be problematic. The risk of relapse when discontinuing a medication is high, at approximately 71%. There are also risks in an untreated pregnancy such as the child being born with a small head circumference or neonatal hypoglycemia.
Previous research has shown that 23% of participants relapsed during pregnancy and 52% relapsed postpartum. Depressive episodes were more likely than manic episodes. One participant in the current study showed concern that her child’s first weeks or months might be impacted by a relapse. Another expressed concern about stress being a risk for relapse. Pregnancy and postpartum periods are incredibly stressful and routines are difficult to establish. This situation does have the potential to cause relapse.
Having support from friends, family, co-workers and professionals is crucial for everyone with bipolar disorder. One patient expressed concern about who would take care of the child if a relapse occurred and how hard it would be even with a dedicated partner. Even with a sturdy support system, another participant stated she could consider pregnancy knowing she had family or friends to help. Both recognized that even with support, pregnancy and raising a child would be difficult for all involved.
This was a small study, but it emphasizes the point that when making the decision of whether or not to become pregnant, it’s important to stay in close contact with all medical professionals involved such as psychiatrists, obstetricians and general practitioners. Being as informed as possible is the best way to make a decision on family planning. Most of the participants in this study expressed that they appreciated being able to rely on their doctors for information and welcomed the conversation.
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