In planning for being pregnant, ladies with bipolar dysfunction and their care suppliers are pressured to make troublesome selections. Within the setting of medicine discontinuation, relapse charges are important, and there’s proof that untreated psychiatric sickness within the mom is related to worse maternal and fetal outcomes. Nonetheless, lots of the medicines generally used to deal with bipolar dysfunction, particularly lithium, carry a small however measurable improve in danger of teratogenesis. The reproductive security of different medicines, together with atypical antipsychotic medicines, will not be effectively characterised. These selections are additional difficult by the paucity of information concerning the course of bipolar sickness throughout being pregnant.
A current examine from the UK seems to be particularly at recurrence of sickness throughout being pregnant and the postpartum interval in a bunch of ladies with bipolar dysfunction. This examine included 128 ladies with DSM-5 bipolar dysfunction (BD) who have been recruited to the Bipolar Dysfunction Analysis Community Being pregnant Examine and have been adopted from 12 weeks of gestation to 12 weeks postpartum. Semi-structured questionnaires, supplemented with clinician interviews and evaluate of the medical report, have been used to evaluate for lifetime psychiatric historical past and psychiatric sickness throughout being pregnant and the postpartum follow-up.
On this cohort, 98 ladies had bipolar I dysfunction/schizoaffective-BD (BD-I group) and 26 bipolar II dysfunction/different specified BD and associated dysfunction (BD-II group). The 2 teams have been related, though the ladies within the BD-II group had earlier onset of sickness and had extra frequent depressive episodes than ladies with BD-I. Data concerning the usage of medicines throughout being pregnant was not reported. About 40% of the ladies in every group used a temper stabilizer through the postpartum interval.
- Perinatal recurrence of sickness was widespread in each teams: 57% (BD-I) and 62% (BD-II) skilled a temper episode throughout being pregnant.
- Ladies with BD-I have been extra more likely to expertise mania/psychosis throughout being pregnant than ladies with BD-II (13.5% vs. 0%).
- Ladies with BD-I have been extra more likely to expertise mania/psychosis inside 6 weeks postpartum (23%) in comparison with ladies with BD-II (4%).
- In ladies with BD-I, mania/psychosis throughout being pregnant was related to a sevenfold elevated danger of postpartum mania/psychosis (RR 7.0, p<0.001).
In ladies with BD-I, despair throughout being pregnant was related to a threefold improve in danger of postpartum despair (RR 3.18, p=0.023).
This examine is per previous reports suggesting that danger for perinatal recurrence of bipolar dysfunction is excessive, with roughly 60% of ladies with bipolar dysfunction (sort I or II) experiencing recurrent sickness throughout being pregnant and/or the postpartum interval. Additionally per earlier reviews is the discovering that depressive episodes are extra widespread than mania in ladies with BD-I and BD-II; nonetheless, mania/psychosis is far more widespread in ladies with BD-I than these with BD-II. (On this examine, solely one of many 26 ladies with BD-II skilled postpartum mania/psychosis.)
The Significance of Remaining Nicely Throughout Being pregnant
Of nice scientific significance is the statement that girls who expertise recurrent sickness throughout being pregnant usually tend to expertise sickness through the postpartum interval. The best danger was noticed in ladies with BD-I; on this examine, ladies who skilled mania/psychosis throughout being pregnant had a sevenfold elevated danger of experiencing postpartum mania/psychosis. General, recurrence of sickness throughout being pregnant (despair or mania) was related to a twofold improve in danger for postpartum sickness.
It’s clear that danger for postpartum psychiatric sickness, together with postpartum psychosis, is excessive in ladies with bipolar dysfunction. Earlier research have demonstrated that danger for postpartum sickness could be decreased considerably with the usage of a temper stabilizer, corresponding to lithium, through the postpartum interval. Nonetheless, given the dangers related to the usage of sure temper stabilizers throughout being pregnant, many ladies and their suppliers elect to discontinue temper stabilizers throughout being pregnant. This examine confirms earlier research documenting excessive charges of recurrent sickness throughout being pregnant in ladies with bipolar dysfunction, however the findings of this examine additionally recommend that the discontinuation of temper stabilizers throughout being pregnant could have important implications for vulnerability to postpartum psychiatric sickness.
In ladies with unipolar despair, relapse throughout being pregnant is a strong predictor of postpartum despair; this examine signifies that for ladies with bipolar dysfunction, recurrent sickness throughout being pregnant, particularly mania or psychosis, is a strong predictor of postpartum psychiatric sickness. Whereas sure temper stabilizers, together with lithium carry some danger of teratogenesis, we have to weigh the comparatively small danger of teratogenesis in temper stabilizers, excluding valproic acid, in opposition to the very excessive danger of recurrent sickness throughout being pregnant within the mom. Avoiding medicine throughout being pregnant and restarting it after supply is probably not the best choice. This examine, and others, means that holding the mom effectively throughout being pregnant will scale back the chance of postpartum psychiatric sickness.
Ruta Nonacs, MD PhD
Perry A, Gordon-Smith Ok, Di Florio A, Craddock N, Jones L, Jones I. Mood episodes in pregnancy and risk of postpartum recurrence in bipolar disorder: The Bipolar Dysfunction Analysis Community Being pregnant Examine. J Have an effect on Disord. 2021;294:714-722.
