Bipolar disorder, sometimes still referred to as manic depression, is a mental disorder marked by alternating periods of elation (manic), and depression. Not only does it cause serious shifts in mood, energy, thinking and behaviour, the cycles of the disorder can last for days, weeks or months at a time. Bipolar disorders also have major adverse social and economic effects that often interfere with a person's ability to work and function normally. For women, bipolar and pregnancy presents an even more challenging endeavour.
Would Bipolar Pose Risks to Your Pregnancy?
Although a bipolar pregnancy is not ideal, bipolar women can still have a healthy pregnancy. However, women who are bipolar and pregnant face some difficult choices, all of which come with significant risk. On the one hand, stopping effective medication during the pregnancy exposes the mother and her infant to potential harmful related bipolar relapses and dysfunction. On the other hand, continuing effective medications during pregnancy that prevent these relapses have also been known to cause congenital malformations or other birth defects in infants. More importantly, women with bipolar disorder are especially at risk during the postpartum phase where the relapse rate can be as high as 30 to 70%. Even more disturbing is that some estimates have put bipolar women at 100 times more likely to experience a severe mood disorder called postpartum psychosis.
Plan Ahead If You Have Bipolar and Want a Baby
Any bipolar woman of childbearing age should keep the possibility of pregnancy in mind during her treatment, even if she doesn't plan on becoming pregnant anytime soon. This is because unplanned pregnancies can occur in all women, including those with bipolar disorder. With proper planning, it's possible to have the medications adjusted, and bipolar and pregnancy can be monitored closely for any developments that may need attention. For those women who are bipolar and want to become pregnant, careful planning before conception is the key to a healthy pregnancy. This plan enables a woman to collaborate with her healthcare professional in order to make an informed decision as it relates to her medications.
Navigating Pregnancy with Bipolar Disorder
1. Bipolar Medications During Pregnancy
Even though there are no cures for bipolar disorder, it can typically be managed with appropriate medications, including certain antipsychotic medications and mood stabilizers. Some women who choose to continue bipolar medications have healthy pregnancies. However, some medications have increased the risk of birth defects during the first trimester, including defects of the brain and spinal cord, and heart defects. After delivery, cognitive/behavioral disorders and developmental delays have been noted in such children.
Your healthcare professional may suggest gradually stopping or changing medications. Another option might include continuing the medication along with regular testing to ensure the health of the baby. What is not an option is discontinuing your medication before consulting your doctor, as this will cause more harm than good. The following information should help you reach an informed decision in conjunction with your doctor for the best possible outcome.
Taking multiple anticonvulsants pose a higher risk to your fetus than taking just one. Although rare, lithium poses a risk for a certain kind of heart defect, and unless the benefits outweigh the risks, lithium is sometimes not recommended during the first trimester of pregnancy. However, when lithium is continued after delivery, it can reduce the rate of relapse from 50%, down to 10%, and lithium may be a better choice for you than other mood stabilizers. You can help reduce the risks from lithium by:
- Limiting your salt intake to prevent lithium toxicity
- Staying hydrated
- Monitoring thyroid hormone levels and kidney function in infants that are breastfeeding
- Monitoring lithium levels in both you and your child, (medical experts suggest every 6 - 8 weeks)
Alternative anticonvulsants such as carbamazepine (Tegretol) and valproate (Depakote) may lead to birth defects affecting the formation of the brain and spinal cord. Most medical experts agree that it is a good idea to stop using them during the first trimester of pregnancy, and although little is known about the reproductive safety of lamotrigine (Lamictal), it may be a useful alternative for bipolar and pregnancy issues.
There's not a lot of information about the effects of antidepressants in bipolar and pregnancy. Generally, these antidepressants, such as Zoloft (sertraine), Prozac (fluoxetine, and Celexa/citalopram) are a safe option during pregnancy. However, your doctor will need to watch you closely for any mood swings or multiple episodes during the pregnancy.
Important note: Antidepressants may also increase the risk of mania. This is a concern if mood stabilizers have been stopped.
Antipsychotic medications are notably more effective than anticonvulsants for treating mania, and haloperidol performs the best in effectiveness. The generally known reproductive safety of haloperidol when compared to other medications may be appealing for the treatment of mania during pregnancy. Other antipsychotic drugs include:
- Risperdal (risperidone)
- Zyprexa (olanzapine)
- Seroquel (quetiapine)
- Abilify (aripiprazole)
- Latuda (lurasidone)
- Geodon (ziprasidone)
2. Electroconvulsive Therapy (ECT) During Pregnancy
Electroconvulsive therapy (electroshock) is a relatively safe and effective treatment for bipolar and pregnancy if precautionary steps are taken to decrease the potential risks, such as:
- Monitoring the baby's oxygen levels and heart rate during the ETC
- Intubation to reduce the risk of aspiration or regurgitation
- Encouraging the mother to eat healthy and stay well hydrated to prevent premature contractions
3. Other Steps You Can Take
It's important for a bipolar mother to exercise regularly to help manage stress, and maintaining structure in their daily routine. These self-help steps can assure a good night's rest, with a reduced risk for rapid mood swings. Moreover, psychotherapy has been known to help bipolar women who are also pregnant.
Can You Just Leave the Bipolar Disorder Untreated?
Women have to weigh these risks against the risks of untreated bipolar and pregnancy. Untreated or uncontrolled bipolar disorder can expose expectant mothers to behavioral risks associated with relapses. These women are also at risk for impulsive behaviours, such as substance abuse, unplanned pregnancies, family functioning, poor neonatal care, and suicide/infanticide. Children with low birth weights, and brain development disorders have also been attributed to bipolar mothers who have discontinued medications.