Pregnancy Outcomes in Women with Bipolar Disorder
A recent review of the topic of bipolar and pregnancy from the MGH Center For Women’s Mental Health on November 14, 2016 sparked us to write this post.
When talking with a bipolar woman contemplating pregnancy there are two considerations: what additional risks to the unborn child are created by taking psychiatric medication and what risks exist because of bipolar disorder itself.
Studies of pregnant women with unipolar depression, have shown that untreated psychiatric illness in the mother may have a negative impact on pregnancy outcomes, influencing the length of gestation and birthweight.
A recent study reviews and analyzes pregnancy outcomes in women with bipolar disorder.
In this report, researchers reviewed published studies which included women with a diagnosis of bipolar disorder prior to pregnancy who were pregnant and/or followed for one year after childbirth.
The researchers found that adverse pregnancy outcomes, including hypertension during pregnancy and bleeding occurred more frequently in women with bipolar disorder. Women with bipolar disorder also had increased rates of induction of labor and C-section. Finally, women with bipolar disorder were more likely to have babies that were unusually small for their age.
The clearest finding in this meta-analysis was that women with bipolar disorder were at increased risk for psychiatric illness during pregnancy and the postpartum period. During pregnancy, rates of mood episodes varied across the studies from 9 to 18%. Mood episodes were more common after birth, with studies finding the frequency of a significant mood episode right after birth between 25 and 79%. [Author’s note: I have to question this data because when there is aggressive follow up – for instance in my practice where I meet with all women in the first two days after birth I find the incidence of serious mood disorders to be much less than this number].
Unfortunately, this study was not able to distinguish between the risk from bipolar disorder and the risk caused by medications. Only one study has attempted to distinguish between these two risks.
Boden and colleagues analyzed pregnancy outcomes in women with bipolar disorder and concluded that bipolar disorder in women, whether treated with medication or not, was associated with worse pregnancy outcomes. The study suggests that while exposure to mood stabilizers during pregnancy may carry some risk, exposure to medication is not the primary reason for adverse pregnancy outcomes in women with bipolar disorder. It is important to note that the illness itself– or behaviors associated with having the illness– may also have a negative effect on pregnancy outcomes.
Boden R et al. Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: Population based cohort study. BMJ 2012; 345:e7085.
Rusner M, Berg M, Begley C. Bipolar disorder in pregnancy and childbirth: a systematic review of outcomes. BMC Pregnancy Childbirth. 2016 Oct 28;16(1):331.