Many women with bipolar disorder become pregnant or plan to have children at some point in their lives. Pregnancy is a very risky period for women with bipolar disorder, and women with bipolar disorder are often discouraged from having children. But just because you have bipolar disorder, doesn’t mean you can’t safely have children. Carefully planning for pregnancy and working closely with a doctor can help you manage your bipolar disorder and avoid risks to your unborn baby.
Bipolar Disorder and Pregnancy: The Risks
Pregnancy causes hormonal fluctuations that can aggravate bipolar symptoms and make women more vulnerable to depressive and manic episodes. Some women report that these episodes are worse than any episode they’ve experienced before. Here are some statistics about the risks women with bipolar disorder face during pregnancy:
– According to the National Alliance on Mental Illness, pregnant women and new moms with bipolar disorder are seven times more likely to be hospitalized and two times more likely to have a recurrent episode compared with women who aren’t pregnant or who haven’t recently delivered.
– Two studies reported in the Australian and New Zealand Journal of Psychiatry found that nearly half of women with bipolar disorder report their symptoms worsened during pregnancy. The post-partum period is also a risky time for women: the risk of psychosis increases from 10% to 20% and the relapse rates for women with bipolar disorder are as high as 67% to 82% within 3 to 6 months after childbirth.
These statistics are not meant to scare you away from having children; rather, they’re meant to drill in the importance of careful planning during pregnancy and well before conception occurs. But since many pregnancies are unplanned, all women of childbearing age who have bipolar disorder should talk to their psychiatrists about managing bipolar disorder throughout pregnancy, regardless of whether or not they plan to have children.
Bipolar Disorder and Pregnancy: Safely Using Medications
A recent study by the American Journal of Psychiatry found that women who discontinue bipolar medications around the time of pregnancy face substantial risk of relapse, especially if they stop taking their medication abruptly. The study reported women who discontinued medication between six months prior to conception and 12 weeks after conception were more than twice as likely to suffer a recurrence of at least one episode of the illness (85.5% compared to 37%). These same women experienced bipolar symptoms throughout 40% of the pregnancy, compared with only 8.8% of the time for women who continued medications throughout the pregnancy.
The problem with continuing bipolar medication during pregnancy and lactation, however, is that some medications can cause birth defects and side effects in newborns. This leaves women having to weigh the risks of untreated bipolar disorder vs. the risks and rewards of certain medications. The most important thing women should do is talk to their doctor and psychiatrist to develop a plan that is tailored to her individual needs.
This plan may include alternative methods of bipolar treatment, such as ECT (electroconclusive therapy), which is considered the best alternative to bipolar medication during pregnancy. Other ways to decrease the risk of relapse during the post-partum period include planning for extra support, especially at night, to allow the mother to get adequate periods of uninterrupted sleep as irregular sleep patterns can seriously affect mood in people with bipolar disorder. Holistic treatments such as massage, acupuncture and yoga may also provide relief from bipolar episodes.
If medication must be used, some studies show lithium can be used shortly before delivery or within 48 hours of delivery to reduce the risk of relapse. This, of course, must be closely monitored to prevent neonatal toxicity. First-generation antipsychotics such as Haldol and Thorazine are also considered safer that anticonvulsants such as Depakote and Tegretol. If mothers wish to use antidepressants during the breastfeeding period, they can help minimize exposing their infant to the medication by committing to a schedule in which they take their pills immediately after breastfeeding and waiting 7 to 11 hours before breastfeeding again, using formula as needed. Infants should be closely monitored for side effects during this time.
Bipolar Disorder and Pregnancy: Conclusion
Pregnancy is a risky period for women with bipolar disorder, but that doesn’t mean women are sentenced to a life without children. Managing bipolar disorder during pregnancy is possible with careful planning and commitment. If you have bipolar disorder and are pregnant or plan to become pregnant, talk to your doctor and psychiatrist about developing a plan to help you avoid relapse and minimize risks to your child.
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