Labour and delivery complications at birth and later mania

Browne, Roy; Byrne, Majella; Morris, Mary; O’Callaghan, Eadbhard; Mulryan, Niamh; Scully, Ann; Kinsella, Anthony; McNeil, Thomas F.; Walsh, Dermot

doi:10.1192/bjp.176.4.369

Cited by 29 publications

(6 citation statements)

References 23 publications

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“…Mental health risks to women include the occurrence of mood episodes during pregnancy, rates of which varied across the studies from 9 to 18 %. Mood episodes were more common in the postpartum period [73, 75], ranging from 25 to 79 %, with differences possibly due to small sample sizes in some studies [36, 44]. It has been suggested that this may be due to placental hormones increasing throughout pregnancy, and their abrupt cessation after birth [75].…”

Section: Discussionmentioning

confidence: 99%

“…1). Reasons for exclusion were: drug related issues (21 papers, [14, 18–37]), no focus on the chosen study group (six papers, [38–43]), outcomes in women not diagnosed before pregnancy (two papers, [44, 45]), mixed groups bipolar disorder and schizophrenia (two papers, [46, 47]), discussion paper (two papers, [48, 49]), gender mixed groups also including men (one paper, [50]), duplicates (one paper, [15]). Occasionally it was difficult to separate the different diagnoses that were included in the sample; for example, in Doyle et al [46] it was not possible to find separate data for the three included groups: BD I, BD II and schizoaffective disorders bipolar type.…”

Section: Methodsmentioning

confidence: 99%

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Bipolar disorder in pregnancy and childbirth: a systematic review of outcomes

Rusner

Berg

Begley

2016

BMC Pregnancy Childbirth

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BackgroundBipolar Disorder (BD) is a mental disorder usually diagnosed between 18 and 30 years of age; this coincides with the period when many women experience pregnancy and childbirth. As specific problems have been reported in pregnancy and childbirth when the mother has BD, a systematic review was carried out to summarise the outcomes of pregnancy and childbirth, in mother and child, when the mother has BD diagnosed before pregnancy.MethodsAn a priori protocol was designed and a systematic search conducted in PubMed, CINAHL, Scopus, PsycINFO and Cochrane databases in March 2015. Studies of all designs were included if they involved women with a diagnosis of bipolar disorder prior to pregnancy, who were pregnant and/or followed up to one year postpartum. All stages of inclusion, quality assessment and data extraction were done by two people. All maternal or infant outcomes were examined, and narrative synthesis was used for most outcomes. Meta-analysis was used to achieve a combined prevalence for some outcomes and, where possible, case and control groups were combined and compared.ResultsThe search identified 2809 papers. After screening and quality assessement (using the EPHPP and AMSTAR tools), nine papers were included. Adverse pregnancy outcomes such as gestational hypertension and antepartum haemorrhage occur more frequently in women with BD. They also have increased rates of induction of labour and caesarean section, and have an increased risk of mood disorders in the postnatal period. Women with BD are more likely to have babies that are severely small for gestational age (<2nd-3rd percentile), and it appears that those women not being treated with mood stabilisers in pregnancy might not have an increased risk of having a baby with congenital abnormalities.DiscussionDue to heterogeneity of data, particularly the use of differing definitions of bipolar disorder, narrative synthesis was used for most outcomes, rather than a meta-analysis.ConclusionsIt is evident that adverse outcomes are more common in women with BD and their babies. Large cohort studies examining fetal abnormality outcomes for women with BD who are not on mood stabilisers in pregnancy are required, as are studies on maternal-infant interaction.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1127-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Bipolar disorder in pregnancy and childbirth: a systematic review of outcomes

Rusner

Berg

Begley

2016

BMC Pregnancy Childbirth

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“…This genetic architecture was predicted by the elevated rates of bipolar disorder, unipolar depression, and psychosis in first-degree relatives of bipolar patients (Gershon et al, 1982). Compared with schizophrenia, there is weaker evidence for presumed environmental aetiologies such as obstetric complications or inner city residence (I, (Bain et al, 2000; Browne et al, 2000; Lloyd and Jones, 2002)).…”

Section: Part 2 Consensus Points and Review Fundamentals Of Patient mentioning

confidence: 99%

Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology

et al. 2016

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The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change.

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“…All except one study [Lewis and Murray, 1987] have been carried in small samples, and obstetrical history has been retrospectively obtained through maternal recall. A recent study using obstetrical records of 76 subjects with bipolar disorder and of 76 normal controls matched for year and maternity of birth did not find an excess of OCs in subjects with bipolar disorder [Browne et al, 2000]. No population‐based or cohort study has specifically investigated the link between OCs and bipolar disorder.…”

Section: What Is the Diagnostic Specificity Of The Association Betweementioning

confidence: 99%

Perinatal risk factors for schizophrenia: Diagnostic specificity and relationships with maternal psychopathology

Verdoux¹,

Sutter²

2002

Am. J. Med. Genet.

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Although a growing body of evidence supports the hypothesis that exposure to obstetric complications (OCs) increases the vulnerability for schizophrenia, some questions remain unanswered regarding the diagnostic specificity and the etiological significance of this association. Associations with a history of OCs have been reported for other severe psychiatric disorders, such as autism, anorexia nervosa, or psychotic affective disorder. Thus, OCs may increase in a relatively non-specific way the vulnerability for a range of severe mental disorders, the expression of this vulnerability depending on the interaction between OCs and other risk factors, such as the genetic liability for specific psychiatric disorder, or exposure to later environmental risk factors. The causal pathway between OCs, maternal psychopathology, and psychotic outcome in the offspring is not fully elucidated. The directions of the associations are often bi-directional, and the mediating variables, if any, are not clearly identified. OCs may have a direct negative impact on fetal brain development, may be on the causal pathway between prepartum maternal depression/exposure to stress and increased risk of schizophrenia, or may indirectly increase the risk of child's later psychiatric disorder by acting as risk factors for maternal postpartum depression. The links and possible interactions between somatic perinatal risk factors and maternal psychopathology in the association with offspring's increased vulnerability for psychosis have to be further explored.

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Labour and delivery complications at birth and later mania

Abstract: These findings suggest that obstetric adversity is not a risk factor for later mania.

Cited by 29 publications

References 23 publications

Bipolar disorder in pregnancy and childbirth: a systematic review of outcomes

Bipolar disorder in pregnancy and childbirth: a systematic review of outcomes

Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology

Perinatal risk factors for schizophrenia: Diagnostic specificity and relationships with maternal psychopathology

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