COMMENTARY

The Management of Bipolar Disorder During Pregnancy

Zachary N. Stowe, MD; D. Jeffrey Newport, MD, MS, MDiv

Disclosures

December 14, 2007

In This Article

Introduction

The management of mental illness during pregnancy and the postpartum period, specifically the use of psychiatric medications during pregnancy and lactation, remains the center of vigorous debate. Despite the burgeoning attention, there has been limited focus on the management of bipolar disorder (BPD) over the course of pregnancy.

BPD is a significant and often chronic psychiatric condition that affects 0.5% to 1.5% of individuals in the United States. The emerging literature regarding "bipolar spectrum disorders" suggests that the incidence may be much higher than early estimates. In contrast to major depression, the prevalence of BPD is similar in men and women. Women with BPD typically are more likely to have rapid-cycling (more than 4 episodes per year) and depressive episodes with illness onset in their teens or early twenties.[1] The age of onset usually precedes family planning and necessitates developing management guidelines that address the myths associated with BPD during pregnancy.

General guidelines for the treatment of BPD are available from the American Psychiatric Association (APA),[2] and treatment algorithms from the Canadian Health Network[3] and Texas Algorithm project[4] have outlined incremental levels of intervention for BPD. A recent review of management of women with BPD during pregnancy and the postpartum period provided an overview of the extant data on course of illness and treatment options.[5] The treatment of women with BPD during pregnancy, specifically the use of medications, has also been incorporated into a Practice Bulletin for the American College of Obstetrics and Gynecology (ACOG) published in November 2007.[6]

Navigation of the complexity of the clinical decisions in the management of women with BPD during pregnancy requires a working knowledge of:

 

  • Course of illness;

  • Impact of maternal illness;

  • Available treatment options;

  • Reproductive safety data on treatment options;

  • Pharmacologic strategies to reduce risks; and

  • Incorporation of this information into a general approach to minimize risks.

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