Bipolar Disorder Q&A: How can I best manage bipolar during pregnancy?

By Candida Fink MD

Purple Tablets Asks…

I’m a female of child-bearing age… who has been diagnosed as Bipolar II. The message that the different doctors have given me so far has been “don’t get pregnant.” (In fact, one offended me so much with how she delivered this message that I cancelled my follow-up appointment and got a new psychiatrist!)

There’s a strong family history, so I’m well aware that there’s a risk of having a child with bipolar disorder.

But what I would particularly like to see discussed is how we can make sensible decisions about becoming pregnant – with respect to medications, psychological therapies, family support, etc.

Do I go off the meds, because there’s a risk to the child? Or do I stay on the meds, because I need them to be stable enough to care for it once I give birth? Is there research to guide this decision?

Dr. Fink Answers…

We really have two questions to address here:

• If you have bipolar, should you have children?
• If you have bipolar and you’re pregnant, how can you most safely manage your symptoms during the pregnancy?

I’ll address each of these in turn….

If you have bipolar, should you have children?

Answering this question involves a very complex and personal decision process that will include you, your partner, your psychiatrist, and your OB/GYN. There is a growing body of literature on the patterns of genetic risk related to bipolar disorder and we have previously discussed some of the most current statistics in Part I of a previous two-part series entitled “Bipolar Disorder & Heredity &ndash The Genetic Link.”

The data keeps expanding though and a recent study published out of the University of Pittsburgh indicates that children of parents with bipolar disorder have an elevated risk of developing early onset bipolar disorder, anxiety disorders, and mood disorders, not just standard bipolar disorder. See “Pitt Study Finds Children of Bipolar Parents Have Increased Risk of Psychiatric Disorders” for a summary of the article.

If you have bipolar and you’re pregnant, how can you most safely manage your symptoms during the pregnancy?

As you rightly point out, there are risks to exposing a developing fetus to the medications used to treat bipolar disorder, but there are also risks to a developing fetus from untreated depression or mania during pregnancy. This is in addition to the potential for reducing care-giving ability that you have thought about.

Some of the medications are more clearly teratogenic (prone to causing birth defects) than others, but for many medications, the data is unclear. Certainly, a big part of the work includes close psychiatric monitoring throughout pregnancy and the post partum period. Changing medications, stopping some meds, reducing others, using non medication interventions more aggressively – for example, psychotherapy, light box treatment, etc. – are all possibilities.

Dr. Lee S. Cohen, Director of the MGH Center for Women’s Mental Health, is one of the most published and sensible experts on the topic of using medications to treat mood disorders during pregnancy. The center’s website provides excellent information on many topics related to mental health issues during pregnancy and the postnatal period. The website also contains a link the center’s blog.

Dr. Cohen has a book out that was published in 2005 entitled Mood and Anxiety Disorders During Pregnancy and Postpartum (Review of Psychiatry). His writings and the website are good starting points for obtaining more information and updated discussions about the research regarding specific medications and the general approach to psychiatric medications during pregnancy.

If you have any insights, experiences, or tips to share about managing pregnancy or raising children as a parent with bipolar disorder, please post a comment.

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