Key points about bipolar disorder in pregnancy and postnatal
Treatment issues for bipolar disorder in pregnancy and postnatal
Bipolar disorder occurs in childbearing women and onset of symptoms may be during pregnancy or after the birth of a baby. This may be a first episode or the continuation or relapse from an episode prior to the pregnancy. Symptoms will be the same as those that occur with bipolar disorder at other times however the treatment required may vary when a woman is pregnant or breastfeeding. The focus of fears and depressive concerns can be the wellbeing of the baby, or feelings of inadequacy as a parent.
Read more about bipolar disorder
Women with a history or a family history of bipolar disorder are at increased risk of an episode occurring during pregnancy and after childbirth and they need to be monitored closely for early symptoms. They also have an increased risk of puerperal psychosis. Once a woman has experienced one episode of bipolar disorder or a puerperal psychosis the risk of another episode is high (50-90%).
Prevention of relapse is an important aspect of the antenatal and postnatal care of women. Relapse is common if a woman discontinues her medication without medical advice. If an episode cannot be prevented then early identification and treatment is desirable to minimise the impact of the disorder on mother and baby.
Bipolar disorder has a genetic component so when one parent has bipolar disorder there is a 10% chance that their child will develop the illness. This possibility rises to 40% if both parents are affected.
Jane was a 36-year-old woman who had been feeling unwell since the birth of her baby a month earlier. Her husband thought she had been behaving strangely at times. She could not fall asleep and paced all night, and repeatedly tried to feed her baby when the baby was not hungry. She believed that she was having an affair with the next door neighbour − a fact her husband knew was logistically impossible − and had told her husband she was moving out. On further discussion, Jane’s husband mentioned that she had actually made inappropriate sexual advances to next-door neighbour. Jane was a corporate lending manager with a history of bipolar disorder diagnosed 2 years ago and managed well with lithium. She had discontinued lithium on discovering that she was pregnant, and has not made contact with a psychiatrist for several months, in the belief that her pregnancy would protect her from any further mood episodes. Jane’s husband reported that she had not coped well with breastfeeding; she seemed very disorganised and unable to pick up her baby’s cues. For the last three nights she had stayed up all night cleaning the house and calling friends overseas. She had neglected personal hygiene, was irritable and showed some bouts of unexplained anger towards her husband. |
Women who are receiving treatment for bipolar disorder are encouraged to seek a review from their Doctor when planning a pregnancy so that ongoing care and a plan regarding medications during the pregnancy and after the birth can be arranged. Women who experience an episode of bipolar disorder during pregnancy or after a birth may require specialist care by a Psychiatrist.
Psychologically based therapies play a role in coping with Bipolar Depression even though the primary causes are biological and may require use of medication. Practical assistance and increased levels of social support can assist a new mother with the care of her baby when adjusting to, and undergoing treatment.
The safety and care of mother and baby are of paramount concern and need to be fully assessed on an ongoing basis by all health care professionals involved with ongoing treatment. The availability of family and community supports and local mental health resources will have bearing on the treatment plan.
See our Factsheet: Treatments for bipolar disorder during pregnancy and the postnatal period
Amongst pregnant and breastfeeding women with bipolar disorder there are special issues associated with the use of medications and specialist care by a Psychiatrist is recommended. The need for effective treatment has to be balanced against the risk to the foetus and infant of the mother using medication. Electroconvulsive therapy is sometimes used when a woman is pregnant and certain types of medications are contra-indicated.
Use of mood stabilisers is a vital aspect of treatment for acute episodes and to prevent relapses. The use of medication in pregnancy is very challenging as these medications can cause malformations when used in the first 3 months of pregnancy. Hence you should always be under specialist care at this time and discuss the medication options before pregnancy where possible. High dose folate should be started before becoming pregnant to reduce the risk of malformations.
There may be an argument for being medication-free in the first trimester, however this can only be decided in consultation with your psychiatrist. If medication is ceased over this period there is need for very regular appointments with the psychiatrist and close communication between family and the treating team to pre-empt a relapse whenever possible. If you do remain off medication throughout pregnancy, it should be recommenced immediately postnatally.
See our facts heet: Treatments for bipolar disorder during pregnancy and the postnatal period
Other things such as minimising stress, maximising sleep (especially in the first 1-2 weeks after baby’s birth) and where possible staying on the postnatal ward a bit longer to get help in establishing breastfeeding, are very important.
Close family need to be aware of your condition and available to help care for baby especially in the first few weeks postnatally.
Page last updated: 15-Jan-2009
Depression and Bipolar Disorder Information Australia - Black Dog Institute.
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