Close Monitoring of Pregnant Women with Bipolar Disorder Improves Outcomes

Lexa W Lee

May 29, 2007

May 29, 2007 (San Diego) — Careful follow-up of pregnant women with bipolar disorder (BPD), with close monitoring of their medication and compliance with outpatient psychiatric care, results in obstetrical outcomes similar to both women with major depressive disorder (MDD) and national population statistics, according to a study presented at the American Psychiatric Association 2007 Annual Meeting.

"The outcomes of the bipolar women who were treated carefully were the same as, if not better than, the women with major depression," said lead author Yara Betancourt, a graduate student in the department of psychiatry at Emory University in Atlanta, Georgia. "The national population statistics are not controlled for mental illness. Our study suggests that we can [at least] mimic national statistics by careful monitoring."

Pregnancy Outcomes

Although there is a burgeoning literature on the effects of maternal depression and anxiety on perinatal outcomes, "very limited research" addresses the issue of adequate treatment for BPD during pregnancy and the effects that it can have on outcomes for mother and newborn at the time of delivery, the authors write.

The researchers' goal in this study was to compare obstetrical and neonatal outcome in a well-characterized sample of pregnant women with bipolar disorders (BPD I, II, not otherwise specified [NOS]).

There were 343 women enrolled in the study; 15.5% (53) with a lifetime diagnosis of BPD (as determined by SCID) and 84.5% (290) with a lifetime diagnosis of MDD for comparison.

Mean age was 32.4 years, mean education level, 15.9 years; 91% were white, with the remainder of mixed ethnicities; 84.5% were married or were cohabitating during pregnancy; 98% of the BPD subjects were exposed to 1 or more psychotropic medications during pregnancy (lithium, lamotrigine, atypical antipsychotics); 74% of the BPD group continued their medications throughout their pregnancies.

The researchers did not include as controls any women who took no psychotropic medications during pregnancy because they considered this group too small.

Subjects were prospectively followed throughout their pregnancies to delivery, when they completed a form to report information about delivery procedures and any pregnancy, delivery, or neonatal complications. Preliminary analysis compared obstetrical outcome between these diagnostic groups and the 2004 National Vital Statistics Reports.

There were no significant differences between the patient groups in infant birth weight or gestational age at delivery. The BPD group had infants with significantly higher 1-minute (7.9 vs 7.3, P < .0001) and 5-minute (9.0 vs 8.7, P < .004) Apgar scores than the MDD group.

The outcomes of the BPD patients were as good as or better than those of the MDD patients, as well as the national sample. For example, while low birth weight occurred in 12.5% of the national sample, only 2% of the BPD women had low–birth-weight babies. High birth weight, however, did occur more often among women with BPD (10%) than in the national sample (0.5%). They had lower rates as well of cesarean and preterm births.

There were no statistically significant differences in complications between the 2 patient groups, nor were there any significant differences between the 3 BPD subgroups.

The researchers concluded that the obstetrical outcome in the women with BPD tested was "unremarkable." In addition, there was no evidence that pharmacological treatment adversely affected outcome. Therefore, pharmacological intervention, close follow-up, monitoring of medication, and compliance with outpatient psychiatric care appears to improve overall obstetrical outcome compared with the general population, they conclude.

Finding a Balance

"A pregnant bipolar woman is a real problem in terms of management," said Robert Guynn, MD, professor of psychiatry at the University of Texas—Houston Medical School. "The dilemma is between trying to control her disorder and knowing that many of the medications used to treat BPD, particularly lithium, can potentially cause problems with the fetus, certainly during the first trimester. If the mother relapses, one has to weigh the severity of the BPD and its effect on the mother and the fetus vs the medication."


American Psychiatric Association 2007 Annual Meeting: New Research Session NR 118. Presented May 21, 2007

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