Controlling the symptoms of bipolar disorder during pregnancy has to be done carefully, balancing the benefit of treatment with the risks to both mother and child during this time. It is important to work with both your obstetric doctor and psychiatrist not just when you get pregnant but in the months before attempting pregnancy.
Typically, bipolar disorder appears in the teen and early adult years and will last throughout a woman’s childbearing years and throughout her life. Pregnancy and the potential after effects of bipolar medications can be of great concern to women. There are statistics that indicate that pregnant women and new mothers are seven times more likely to need hospitalization and two times more likely to have a recurrent episode, than those with bipolar disease who weren’t pregnant or haven’t delivered a child.
The National Alliance on Mental Illness or NAMI, has a list of places to go to for support if you have a mental illness such as bipolar disorder. Click here to see.
Preparing For Pregnancy
It is important for anyone planning a pregnancy to examine their lifestyle choices and make sure they are healthy long before conception. This is even more important for those who have bipolar disorder. In order to minimize the woman’s symptoms and risks to any children there should be careful planning which starts long before conception, continues through the pregnancy, breastfeeding, and through the postpartum period.
Any woman who has bipolar disorder should discuss birth control with their doctor and their psychiatrist. Because unplanned pregnancies happen despite tested preventive methods, women who have bipolar disorder should also talk about managing their illness if a pregnancy should occur, whether or not they plan to get pregnant in the near future.
Hormonal changes have been identified as a possible trigger for bipolar episodes and these hormonal shifts are common for women before, during, and after pregnancy.
The American Journal of Psychiatry published a study on the risks taken by those women who stopped taking their bipolar medications at the time of pregnancy. The results of this study showed:
- Those who stopped taking their medication from six months before conception to twelve weeks after conception had more than double the chance of suffering at least one recurring bipolar episode than those who continued to take their medication. (85.5% versus 37%)
- The above women had bipolar symptoms throughout 40% of their pregnancy versus less than 9% of the time for the women who did not forego taking their medications through the entire pregnancy.
- When the women stopped taking the medications abruptly, they were significantly more susceptible to relapse.
All knowledge about bipolar disorder is evolving. There are many unknowns when it comes to what triggers a relapse, what happens when a woman who has untreated bipolar disease gets pregnant and the risks and benefits of specific bipolar disorder medication.
Common Bipolar Medications
Individual treatment for bipolar disorder can vary a little between doctors and what works with your symptoms. But there are some common bipolar medications that have been studied as to the risks associated to the fetus. It is important to note that studies have shown there is less harm done to a fetus that is exposed to only one mood-stabilizing drug than if it is exposed to several medications. Here is a sample of what researchers have found on just two of the bipolar medications.
Lithium is one of the main treatment options for bipolar disorder. It is believed to have minimal risks to the fetus. Women who are being treated with lithium will typically continue this medication throughout their pregnancy. Those women who are being treated with bipolar medication that has a higher risk factor will often switch to lithium if they are contemplating pregnancy or find out that they are pregnant.
While lithium has lower risks than many other choices there are things that the mother needs to do to keep problems at a minimum. For instance she should drink lots of water, staying hydrated to prevent toxicity of this drug in both the fetus and the mother. The doctor will monitor lithium levels at certain points through the pregnancy, during delivery, and right after the baby is born. Monitoring the levels can help prevent the mother from relapsing and will keep the baby from having a toxic level of the drug.
Lithium has been proven to reduce the relapse rate of bipolar disorder in pregnant women from 50% to less than 10% if the drug is continued or started right after giving birth to the child. Lithium is passed through the breast milk so breast-fed babies will need to have their blood tested for lithium levels.
Depakote has been proven to be harmful to an unborn child. If the woman is planning to get pregnant, her doctor will typically change her medication to another mood-stabilizer before she conceives. If an unplanned pregnancy occurs, the woman and her doctors will have to examine the individual benefits of continuing the medication against the risks to the child. There are things that can be done to minimize some of the risks to the fetus. For instance, the mother can take vitamin K in order to prevent or minimize problems to the head and face of the child. The woman can also take a divided dose to reduce risks to the fetus. Once the child is born this drug has been found to be safe for breast-feeding mothers and the child.
If you are taking medication to treat bipolar disorder, it is very important that you talk to your doctor about the possible scenarios if you get pregnant while taking the medication. If you plan to get pregnant, discuss this with your doctor so he can help you plan for this event with the necessary precautions to keep you and the child healthy and risk-free. You should never discontinue your bipolar medications without consulting with your OB-gynecologist and your psychiatrist.