Pregnant Women Face Special Issues in Treatment for Bipolar Disorder

If you’re a woman with bipolar disorder who is pregnant or who plans to have children, you’re probably concerned about the effects pharmaceutical treatment for bipolar disorder can have on your unborn baby. While recent research has shown that the risk of birth defects among pregnant women taking bipolar medication is much smaller than previously thought, you may nevertheless wonder if it’s best to discontinue pharmaceutical treatment for bipolar disorder during your pregnancy for the good of your child.

The symptoms of bipolar disorder vary in severity from one person to the next, and there’s no one answer for a woman wondering how to manage pregnancy and bipolar disorder. However, while discontinuing your medication may eliminate the risk of medication-related birth defects, it will significantly raise your risk of experiencing a bipolar relapse. Your mental illness could have developmental ramifications for your baby both before and after birth.

Bipolar Medication and Birth Defect Risk

In the past, medications like lithium, which are used for the treatment of bipolar disorder, were believed to cause life-threatening or disabling birth defects in a large percentage of babies born to bipolar mothers – in the 1970s, lithium was believed to cause birth defects in 1 in 50 babies born to mothers taking the medication. Newer research has discovered that the risk is more like 1 in 1,000 to 2,000. Other medications administered as treatment for bipolar disorder are considered even more dangerous for developing babies than lithium, like valproic acid, carbemazepine and lamotrigine, which can cause spina bifida, cleft palate and other birth defects. Because of the smaller risk of birth defects with lithium, doctors recommend women with bipolar disorder who want to get pregnant switch to lithium before conceiving.

Risks of Discontinuing Pharmaceutical Treatment for Bipolar Disorder

Though the risk of birth defects for pregnant women taking lithium is small, it’s still too much risk for many pregnant women managing bipolar disorder. However, a pregnant woman with bipolar disorder is almost certain to experience a relapse of bipolar symptoms if she discontinues her medication during pregnancy – relapse rates among bipolar women who stop taking their medication during pregnancy can be as high as 70 percent. Pregnancy is a high-stress time; the anxiety and sleep disruptions associated with carrying a child and giving birth can easily trigger a bipolar relapse.

The prospect of a bipolar relapse during pregnancy threatens the well-being and even the life of both mother and child. Women who discontinue pharmaceutical treatment for bipolar disorder during pregnancy spend an average of 40 percent of their pregnancies experiencing illness symptoms. A woman who is experiencing a depressive episode is less likely to practice the good self-care necessary for the unborn baby’s health and development. Such a mother-to-be is even vulnerable to suicide. Women who discontinue treatment for bipolar disorder during pregnancy are also 100 times more likely than women without bipolar disorder to experience postpartum psychosis, which can even lead to infanticide.

Managing Pregnancy and Bipolar Disorder

While many women with bipolar disorder choose to stop taking their medications before conception or after they discover they’re pregnant, psychiatrists don’t recommend this, especially for women with severe psychiatric symptoms. If you stop taking your bipolar medications during pregnancy and experience a severe recurrence of symptoms, you may need to take even higher doses of medication to bring your symptoms back under control. And the higher your dosages, the higher your risk of birth defects.

Lithium has the fewest risks for pregnant mothers and babies, though it’s important to make sure you drink plenty of water to avoid lithium toxicity. Your doctor will want to monitor your blood carefully for high lithium levels, especially during and right after your delivery. Your baby’s blood will also need to be tested for high lithium levels. If you choose to breastfeed, lithium is secreted in milk; your baby’s blood will need to be monitored for high lithium levels if you choose to breastfeed after birth. Your doctor may also recommend a first-generation or second-generation antipsychotic medication, which is not believed to cause birth defects, or receive ECT treatment for bipolar disorder during pregnancy.

If you are taking valproic acid or carbemazepine, you should switch to a safer medication before you conceive. If you find out you’re pregnant while still taking valproic acid, you may want to break down your single daily dose into several daily doses to reduce the risk of side effects. Your doctor may also recommend a vitamin K supplement.

Managing bipolar disorder and pregnancy is challenging, but not impossible. If you have questions about receiving bipolar disorder treatment while pregnant, call 888-415-0708 to set up an appointment with our psychiatrist.